Menstrual migraine treatment and prevention

Share on Pinterest

Migraine is three times as common in females as it is in males. According to the United Kingdom’s National Health Service (NHS), more than half of females with migraine notice a connection between their symptoms and their menstrual cycle.

The term “menstrual migraine” describes episodes that appear to be caused by hormonal fluctuations.

The authors of a 2016 study report that there are two subtypes of menstrual migraine. Those with “pure menstrual migraine” only have episodes during menstruation, and the researchers cite a prevalence of 1%.

The second subtype is called “menstrually related migraine.” In this case, migraine episodes often occur around a period, but not always —menstruation appears to be one of several contributing factors. About 6–7% of people have this type of migraine.

Menstrual migraine can also result from hormonal changes during perimenopause, pregnancy, or a course of oral contraceptives.

Migraine is a condition that often causes moderate-to-severe headaches on one side of the head. Throbbing pain tends to be the main symptom, but many people experience others, including:

• nausea
• vomiting
• sensitivity to light, sound, or both
• aura — audio-visual disturbances that tend to appear before other symptoms

People with menstrual migraine often experience episodes during or around their periods. According to the NHS, a person with this issue is most likely to experience an episode 2 days before a period or in the first 3 days of a period.

However, these episodes may occur when starting hormonal medication or during pregnancy or perimenopause.

Episodes triggered by these hormonal shifts may be more frequent, severe, or difficult to treat than others.

Generally, doctors diagnose migraine if a person has experienced migraine symptoms lasting 4–72 hours on at least five occasions.

Keeping a symptom diary can help a person tell whether their migraine symptoms are linked with their menstrual cycle or birth control, for example.

Scientists are not entirely sure what causes migraine. However, inflammation may play a role.

Chemicals in the brain can cause blood vessels in the area to swell. If this irritates nearby nerves in the head, it can cause neurological changes and pain.

Hormones influence inflammation levels. They act as messengers and can change how parts of the body behave, including the blood vessels.

Researchers have suggested two possible ways that female sex hormones may influence migraine. The symptoms may be triggered by estrogen or prostaglandins.

Estrogen levels fall just before a period, during perimenopause, and when the person stops taking a medication that contains estrogen. For example, these levels drop during the pill-free week in many birth control regimens.

Estrogen can affect pain sensations, which may be why reduced levels can trigger migraine episodes.

Prostaglandins are chemicals responsible for raising inflammation levels, and the body releases them before a period.

Other things that may increase the risk of developing migraine include:

• genetic factors
• female sex
• underlying health conditions that cause inflammation or otherwise trigger migraine

Triggers

For some people with menstrual migraine, a period may be the only trigger. Others may have several triggers beyond hormonal changes. These could include:

• certain foods and drinks, including those with alcohol or caffeine
• strong smells
• bright lights
• too much or too little sleep
• stress
• anxiety
• being hungry or dehydrated
• weather changes
• sleep apnea
• teeth grinding or clenching
• jaw joint disorders

A single factor may not cause an episode, but a combination may do so. Also, a person may be more sensitive to other triggers before or during their period.

Medication may prevent existing symptoms from worsening. It is best to take this as soon as the symptoms appear.

A person might try nonsteroidal anti-inflammatories (NSAIDs), such as aspirin or ibuprofen (Advil). These are available over the counter.

Or, a doctor may prescribe a medication from the triptan family of drugs. One example is sumatriptan (Imitrex).

Other treatment strategies include:

• lying down in a dark, quiet room
• drinking water or having a light meal, if hunger or dehydration are triggers
• sleeping, which can shorten or stop episodes in some people

If migraines occur often, it may help to keep an emergency migraine kit handy, which might include:

• medication
• an eye mask
• cool or hot packs
• a bowl, if vomiting is a possibility

There is no cure for migraine, but there may be ways to reduce the number of episodes.

Anyone with menstrual migraine should try to prevent sudden drops in estrogen levels. A person’s options might include:

• Switching birth control types: This might involve taking a different type of pill or opting for an implant, for example. It may be an especially good idea to switch to a continuous form of birth control — one that does not involve a weekly break.
• Trying estrogen gel or patches: A doctor may prescribe these for people with regular periods. A person applies the gel or patch before their period to prevent a drop in estrogen.
• Using hormone replacement therapy: This is not a treatment for menstrual migraine — it treats symptoms commonly associated with perimenopause or menopause. As an added benefit, a person might find that it relieves their menstrual migraine. However, for some people, it makes migraine episodes worse.

It is important to note that a person who has migraine with aura should not be taking birth control that contains estrogen. In general, anyone who experiences aura should let their doctor know.

Other migraine prevention strategies include:

• Identifying other triggers: Avoiding triggers, when possible, is key. It may help to keep a diary of migraine symptoms and any possible triggers, such as foods and stress levels. Over time, a pattern may emerge.
• Addressing deficiencies: Some research suggests that specific nutritional deficiencies may increase the risk of headaches and migraine. Taking magnesium, in particular, may work as a preventive treatment.
• Taking other medications: Some people find that certain antidepressants, anticonvulsants, and beta-blockers help with migraine.
• Receiving specialist treatments: These include procedures such as transcranial magnetic stimulation and Botox. They tend to be less widely available than medications, however.
• Using complementary therapies: Acupuncture and biofeedback are helpful for some people with migraine. They work best alongside more standard treatments.

It is important to be aware of the possible side effects and interactions of any drug or supplement and to consult a doctor before trying a new approach.

Anyone who regularly has menstrual migraine episodes should contact a doctor. They may refer the person to a migraine specialist who can help develop an effective treatment plan.

It is also important to consult a doctor if migraine episodes are getting worse, if treatments are not working, or if any treatment is causing side effects.

Sometimes, migraine symptoms resemble those of other health issues. A person should receive emergency care if they experience:

• a headache that is worse than any in the past
• a sudden headache that feels explosive or violent
• a severe headache with neck stiffness
• a headache that worsens over 24 hours
• a headache that follows a head injury
• a headache that occurs soon after activities such as weightlifting, aerobics, jogging, or sex
• a severe headache in just one eye, with redness in that eye
• a headache and any of the following:
  • confusion or disorientation
  • a seizure
  • slurred speech
  • a change in vision
  • difficulty moving the arms or legs
  • a loss of balance
  • memory loss
  • nausea
  • vomiting
  • pain while chewing
  • weight loss
  • a fever

People who get periods and have migraine often experience episodes around the time of menstruation. A person may also have episodes during pregnancy, perimenopause, or while using hormone-containing medications, such as some forms of birth control.

There are various ways to significantly improve the quality of life for people with frequent migraine episodes. The best approach might involve taking medications to prevent or ease symptoms, identifying and avoiding triggers, and taking supplementary magnesium.