Treat & Prevent Menstrual Headaches
A migraine headache is a neurological condition in which patients experience severe head pain along with sensitivity to light, sound, or smells.
About 2/3 of women who suffer migraines have them around the same time as their period. Migraine attacks that start between two days before a womans menstrual period and the third day of flow are usually considered menstrual migraines.
Some women may be able to prevent menstrual migraines with a mini-preventive treatment by taking medications for 5 to 7 days in a row prior to the onset of the menstrual migraine attacks.
Medications used to prevent menstrual migraines may include those mentioned in the table below.
Other Treatment Options
Hows A Menstrual Migraine Diagnosed What Tests Are Done
Your healthcare provider will want to establish a history of your migraine-related symptoms, likely asking you to:
- Describe the severity and location of your pain. Is the pain pounding? Pulsing? Throbbing?
- Tell how often you get migraine headaches.
- Remember if anything makes your headache better or worse.
- Discuss what medications you take to relieve the pain and how often you take them.
- Talk about the activities, foods, stressors, or the situations that may have brought on the migraine.
- Remember if anyone in your family gets migraine headaches.
- Tell how you felt before, during and after the headache.
Your healthcare provider may also order blood tests and imaging tests to make sure there are no other causes for your headache. An electroencephalogram may be ordered to rule out seizures.
Its helpful to both you and your healthcare provider if you keep a migraine journal. Take note of what symptoms you get, how long your symptoms last, and what makes your menstrual migraine better or worse. You and your healthcare provider may be able to use that information to help you heal, and possibly prevent or anticipate your migraine.
International Classification Of Headache Disorders Iii
A1.1.1 Pure menstrual migraine without aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.1 Migraine without aura and criterion B below B. Occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other times of the cycle
A1.1.2 Menstrually related migraine without aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.1 Migraine without aura and criterion B below B. Occurring on day 1 ± 2 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle
A18.104.22.168 Pure menstrual migraine with aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other times of the cycle
A22.214.171.124 Menstrually related migraine with aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Occurring on day 1 ± 2 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle
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Prophylactic Menstrual Migraine Therapy
Prophylaxis may either be perimenstrual or continuous . Many of the regimens suggested for perimenstrual migraine prophylaxis depend on regular menstruation and the ability to predict headacheonset in relationship to menses. Perimenstrual prophylaxis commences a few days before the period is expected and continues until the end of menstruation. In women whose cycles are difficult to predict, continuous prophylaxis with standard migraine prophylactic agents is called for .
NSAIDs are considered first-line agents for perimenstrual prophylactic therapy in patients with either menstrual-associated migraine, or PMM, when the timing of menstruation is predictable. Different classes of NSAIDs should be tried because response may vary in a given individual. Ergot derivatives can also be effective when used as perimenstrual prophylactic drugs around the time of menstruation. Risks for rebound headaches are minimal, given the limited duration of treatment when drugs are used perimenstrually. Frovatriptan, naratriptan, and zolmitriptan have been found to be effective for perimenstrual prophylaxis and are included in the AAN and AHS guidelines on migraine prophylaxis . It is worth noting that severe menstrually related migraine may respond better to short-term or perimenstrual prophylaxis while on a chronic preventive agent.
Jan Lewis Brandes, in, 2003
What Causes Menstrual Migraine
There is a link between migraine and falling levels of the hormone oestrogen. The natural drop in oestrogen levels before your period starts is linked to menstrual migraine. Women who have heavy and painful periods have higher levels of prostaglandin , which has also been identified as playing a role in a menstrual migraine.
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Natural Remedies For Menstrual Migraines
There are several ways you could use this information in this article. You could try each natural method by itself for two months, keeping a diary of what happens. The problem is that your solution may not be found for another year if you do it this way.
Thus, a better way to try these natural remedies to prevent menstrual migraines is to try all of them at once. The reason why this is the best method is that researchers have discovered that most people who have migraines have multiple vitamin and mineral deficiencies.
So if youre taking only one tablet of magnesium daily, thats a good thing, but youre neglecting the other six or seven nutrients that youre low in. In essence, youre worsening your other vitamin and mineral deficiencies by not addressing them.
Each of the natural ways to get rid of menstrual migraines on this list may work on its own. However, its easier to take all of them for three to four months, eliminate your migraines and then back of the supplements one by one, with the exception of the period vitamin. Youll stay on that to provide your bodys minimal needs during its menstrual cycle.
When Should I Seek Immediate Help Or Contact My Healthcare Provider
Schedule a visit with your healthcare provider if:
- The number or severity of your migraines increase, or your headache pattern changes.
- Youre experiencing new or different side effects.
- Your medications no longer seem to be working.
- Your headache comes on suddenly.
- You are experiencing the worst headache of my life.
- You have a headache after experiencing a head injury.
- You are having neurologic symptoms that you have never had before, including speaking difficulty, balance problems, vision problems, mental confusion, seizures, or numbing/tingling sensations.
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What Questions Should I Ask My Healthcare Provider About Menstrual Migraines
- Am I experiencing a menstrual migraine or another type of migraine?
- Should I change any of the medications Im taking?
- What treatment do you recommend?
- What medications should I take?
A note from Cleveland Clinic
A migraine is more than a bad headache. Not only can menstrual migraines get severe, but women have reported that they can be even worse than a migraine that occurs when theyre not on their period. Talk to your healthcare provider about your symptoms. There are preventative measures and treatment options. A menstrual migraine might not be something you just have to live with every month.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
Have I Got Menstrual Migraine
You might think it would be glaringly obvious but Ive lost count of the number of women who didnt connect migraine with their menstrual periods until they started to keep a diary and only then noticed a pattern. Diaries are really important not just to establish a pattern of attacks but also to assess how that pattern changes with treatment. It doesnt matter if its a paper diary, an app, or just making notes on a calendar. If you find that you are consistently experiencing migraine attacks starting within a few days before or after the start of your period, and these attacks are more troublesome than attacks at other times of the month, it is highly likely that you have menstrual migraine.
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Breaking Down Three Main Treatment Strategies For Menstrual Migraine And How To Pick The Best Option For You
For nearly two out of three women with migraine, attacks occur around the same time as their period. By definition, if you have migraine attacks that start between the two days before your period and the third day of flow, you likely have menstrual migraine. These attacks are often more severe, longer, and cause greater light sensitivity than attacks occurring other times of the month.
Menstrual migraine is caused by the rapid drop in estrogen levels that occurs just prior to your period. I have patients that tell me, Arent headaches a part of having a menstrual cycle? says Dr. Paru David, an internist who works in the division of womens health internal medicine at Mayo Clinic in Arizona. I educate them that not all women have headaches during their menstrual cycles.
Migraine attacks occurring just before and during a womans period can be the most challenging kind to treat. They do not always respond to the same medicines that work on migraine attacks happening at other times. The reason medications dont work the same is not entirely clear. But its likely related to estrogens effects on other chemicals.
What Are Hormones What Is Estrogen
Hormones are often called your bodys chemical messengers. Theyre in your organs, tissues and bloodstream and theyre made by the endocrine glands. Examples of endocrine glands include your thyroid gland, adrenal glands and pituitary gland. If you have too little of a certain hormone, or too much, that can throw your entire system off balance.
Estrogen and progesterone are the two main sex hormones in women. Estrogen causes female physical features, sets off puberty and aids with reproduction. It also affects your cholesterol, controls your menstrual cycle, protects bone health and affects your heart, skin, bones, brain and other tissues. Its mostly produced by your ovaries.
Your levels of estrogen change. Theyre at the highest amount in the middle of your cycle and the lowest amount when youre on your period. When youre in menopause, they drop very low.
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Natural Pms Migraine Relief Method #2 Coenzyme Q10
Take 100 mg Coenzyme Q10 once daily, at the end of your meal. It can be any meal.
Natural PMS Migraine Relief Method #3. Zinc
Take 50 mg zinc citrate or glycinate or sulphate once daily at the end of a meal. Take another 25 mg zinc that also includes 2 mg copper in it at the end of another meal.
Natural PMS Migraine Relief Method #4. Vitamin B Complex
Take a 25 mg B complex formula daily in the morning at the end of your first meal. A 25 mg B complex means there is 25 mg vitamin B1, 25 mg vitamin B2, and 25 mg vitamin B6 in the formula. There should be more than 25 mg niacin or vitamin B3 in the formula. Your formula also must have at least 400 mcg folic acid, 300 mcg biotin, and 10 mg pantothenic acid. It must also contain vitamin B12, inositol, choline, and PABA.
Natural PMS Migraine Relief Method #5. Period Vitamin
Taking a period vitamin is like adding a multivitamin/mineral / herbal formula that is designed for women who are having their period. Your needs for nutrients are much different than men your own age, your mother, and your grandmother, so dont expect that by taking the same vitamin/mineral supplement they take, you are making a wise choice.
Take all the supplements for at least two months. Youll see a big difference in your migraines during your period. This natural help you are providing is a good step forward in figuring out how to manipulate your own health.
Hormones And Head Pain: Whats The Deal
As with most things period related, hormones are to blame. Before your period, estrogen and progesterone levels rise. Then, those levels come crashing down as a signal to your uterus to let that lining go.
This fall in estrogen can trigger headaches. Since birth control regulates this hormonal roller coaster, for some people it can decrease period headaches. For many, birth control makes period headaches worse.
If you have a NuvaRing, headaches during periods are even more common.
Pro tip: If youre already prone to migraines, you should not use the NuvaRing, as it increases your chances of blood clots and continued headaches.
If youre on a hormonal pill based birth control, sometimes skipping the placebo week can get rid of period headaches .
If you noticed your headaches got much worse after starting hormonal birth control, talk to your doctor. You may need to switch pills or your method of birth control to keep headaches at bay.
Though hormones are a background cause of all period headaches, there are four types of menstrual brain pain that are all slightly different.
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Causes Of Hormonal Headaches
Headaches, especially migraine headaches, have been linked to the female hormone estrogen. Estrogen controls chemicals in the brain that affect the sensation of pain. A drop in estrogen levels can trigger a headache. Hormone levels change for a variety of reasons, including:
Menstrual cycle: Levels of estrogen and progesterone fall to their lowest levels just prior to menstruation.
Pregnancy: Estrogen levels rise in pregnancy. For many women, hormonal headaches go away during pregnancy. However, some women experience their first migraines during early pregnancy and then find relief after the first trimester. After giving birth, estrogen levels fall rapidly.
Perimenopause and menopause: Fluctuating hormone levels in perimenopause cause some women to have more headaches. Approximately two-thirds of women who experience migraines say their symptoms improve as they reach menopause. For some, migraines actually worsen. This may be due to the use of hormone replacement therapies.
Oral contraceptives and hormone replacement therapy: Birth control pills and hormone replacement therapy can cause hormone levels to rise and fall. Women whose migraines come as a result of hormonal changes while on the pill typically have migraine attacks during the last week of the cycle, when the pills do not have hormones.
Which Treatment Option Is Best For You
Keeping a diary of your headaches, including when they occur in relation to your menstrual cycle, as well as their severity and response to treatment, will help your doctor determine the presence of menstrual migraine. There are not any blood tests or any type of imaging that can be done to diagnose this, says Dr. David. Its purely done based on the history.
A headache and menstrual diary can also help you and your doctor identify the best treatment for you. Women with menstrual migraine who have painful cramps may benefit more from a NSAID strategy with a triptan for rescue. Those who have predictable cycles and migraine attacks may benefit from a mini-prevention strategy. Those who dont have regular cycles can try other options.
It is also important to discuss with your doctor any personal risk factors you may have for taking oral contraception, such as an increased risk of stroke, heart disease or blood clots, as hormonal birth control can affect women with migraine differently. Please let your provider know if you have migraine with aura when discussing hormonal options.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
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What Triggers Migraines In Women
In addition to a drop in estrogen, birth control pills and hormone replacement therapy for menopause can change the frequency or severity of migraines. If you notice your migraine headache getting worse after starting one of these medications, it may be worthwhile to ask your healthcare provider for a medication that contains a lower dose of estrogen, or ask for a change from an interrupted dosing regimen to a continuous one.
What Can I Do To Help Relieve The Symptoms Of A Menstrual Migraine
Do your best to figure out what makes your hormone headaches better or worse. For example, if light causes pain and you feel overheated, stay in a cool, dark room. Additional tips include:
- Keep your blood sugar levels up by eating small, frequent snacks. Never miss a meal.
- Learn relaxation techniques.
- Avoid too little or too much sleep, and keep a regular sleep pattern.
- Change your diet, if needed.
- Avoid stress when you can, and learn how to manage it when you cant.
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Menstrual Migraine Is Tough To Treat
Menstrual and menstrually related migraine can be the hardest kind of migraine to treat. can be pretty severe, they can last several days, and they can be quite debilitating, she says.
Even if you have migraine attacks only around the time of your period, for many women that may still mean five days or more a month, says Hindiyeh. In that case, its really time to talk to your doctor about daily preventive treatment options for migraine, she says.
Generally speaking, there are many treatment options for the prevention of migraine and menstrual migraine, says Hindiyeh. Heres a rundown of top medications and lifestyle modifications that can help reduce the frequency and severity of menstrual and menstrually related migraine attacks.