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Menstrual Migraine – Hormonal migraine

Women suffer from migraine far more frequently than men. This is likely because the female hormone estrogen impacts many functions of the brain, including how pain is perceived. When boys and girls are young, the incidence of migraine between the genders are about the same. The staggering difference occurs after puberty – when hormone levels begin to soar – then females begin to far outnumber male migraine suffers.

Because of the drastic changes in estrogen surrounding a woman’s menstrual cycle, often migraine attacks occur in days before or the early part of the menstrual cycle. These types of hormone-related migraines are called menstrual migraines or some might refer to them as period migraines.

Incidence of migraines in women

  • 70 percent of all migraine sufferers are women
  • 18 percent of women experience migraines
  • Women suffer from migraines three times as often as men
  • 5 to 10 percent of adolescent girls suffer from migraines
  • 20 to 25 percent of menstruating women ages 30 to 50 are migraine sufferers
  • Less than 10 percent of postmenopausal women have migraines

Facts about menstrual migraine in women

  • Use of oral contraceptives may change the frequency and severity of migraines
  • Menstrual migraines most often occur two days before their period
  • Menstrual migraines typically last longer, are more severe and are more often accompanied by nausea and vomiting than other types of migraines
  • Many times migraines improve in the last six months of pregnancy
  • Often migraines worsen in the postpartum period, immediately after a woman has given birth
  • For many women, the migraines improve after menopause
  • Migraine attacks in women usually begin with their first menstrual period, which is also called menarche
  • Typically, the first attack of migraine with aura occurs between the ages of 12 and 13
  • The first attack of migraine without aura usually occurs between the ages of 14 and 17
  • A study of more than 18,000 women found that women who were currently using hormone-replacement therapy were 40 percent more likely to have a migraine attack in the past year than those not on HRT
  • A study of 155 women fund that they were twice as likely to suffer a migraine attack in the two days before or the three days after the start of menstruation


How do hormones cause migraines?

Although there definitely appears to be a link between hormones and migraines in women, the exact reason behind this link has not been confirmed. Some researchers speculate that migraine attacks occur because of activity in the brain’s networks that process pain (part of the central nervous system). The pain may also come from widening of the arteries in the brain. Female hormones could impact these areas causing more or less activity which results in migraine attacks or more frequent attacks. It is well established that ovarian hormones have a great influence on a woman’s central nervous system.

Migraines and hormones are closely linked. The International Headache Society describes Pure Menstrual Migraine as migraine attacks that start two days before or three days after the start of the menstrual cycle. Several studies show that between 4 percent and 21 percent of women have menstrual migraine. IHS says Menstrually-related Migraine attacks occur in the same time period as the Pure Menstrual Migraine two-thirds of the time and also may occur at other times. These menstrually-related migraines are twice as common as menstrual migraines and 35 percent to 54 percent of women suffer from this type of attack.

How to prevent menstrual cycle migraine

Some women who suffer from menstrual migraines benefit from taking medications five days to a week each month. They take medicine to prevent menstrual migraine attacks. The prophylactic treatment can be taken before the migraine is expected to start in order to prevent the migraine attack. Some women benefit from over-the-counter drugs for menstrual migraines, while others seek a prescription treatment. As with all types of migraines, doctors usually suggest keeping a record of all migraine episodes in your migraine journal.


Written by: Otesa Miles | Last reviewed: August 2014
Hormone-related headache Pathophysiology and treatment; Therapy in Practice; CNS Drugs Ashkenazi 2006