- Period migraines, aka menstrual migraines, can start anywhere between two days before your period to three days in.
- Menstrual migraines generally are triggered by a drop in reproductive hormones starting from your first period and can continue beyond menopause.
- Preventing recurring migraines can involve daily intake of magnesium supplements, a combination of triptans and NSAIDs, and lifestyle changes.
Abdominal cramps, bloating, and mood swings are but a few distressing period-related symptoms, but throw in hormonal changes, and you may also get painful headaches called menstrual migraines.
A menstrual migraine isn’t your average headache or migraine. In a 2015 study, women with menstrual migraines reported prolonged migraines and more severe symptoms of nausea than women with non-menstrual migraines.
While 70% of migraines occur in women overall, the Cleveland Clinic reports about 60% to 70% of these women find migraines connected to their time of the month. And unlike regular headaches, menstrual migraines happen because of a drop in estrogen and progesterone hormone levels.
Because of its unique cause, treating menstrual periods may require more than an aspirin. The good news is that understanding why it happens makes it easier to know how to treat it. Here’s what you need to know.
What causes menstrual migraines?
Changes in sex hormones are associated with worsening headaches. From the start of a person’s first period, levels of the sex hormones estrogen and progesterone start to fluctuate on a monthly basis. This opens the door for hormone-induced migraines.
“Estrogen levels rapidly decline about five days before the onset of the period. That drop in estrogen is thought to trigger a menstrual migraine,” says Jelena Pavlovic, MD, PhD, a neurologist at Montefiore Medical Center.
Because estrogen and progesterone are essential in regulating menstrual cycles, migraines can start appearing as early as two days before to three days into your period.
Moreover, the MGH Center for Women’s Mental Health reports that while boys and girls have similar rates of getting migraines, the incidence increases dramatically for girls once they get their first period. Over time, adult women will outnumber men in recurring migraines by 3 to 1.
Period migraines return after pregnancy
Not having a period during pregnancy translates to a 50% to 80% migraine reduction in those who suffer from the disease. In addition, a 2006 review noted the likelihood of getting a migraine while pregnant was less than 3%, and those migraines were more typical during the first trimester.
The decreased incidence of migraines is due to increased progesterone and estrogen levels, which are needed to maintain a healthy pregnancy.
However, this doesn’t mean menstrual migraines are gone forever. The 2006 review also found that almost 94% of women experienced migraines returning after giving birth. This happens because estrogen and progesterone return to normal after pregnancy, and that sharp decline can cause migraines to come back.
If you’re breastfeeding, that can prevent estrogen levels from dropping, according to the American Migraine Foundation. However, this is a temporary preventative effect. Once the baby weans off breastfeeding, migraines may reappear again.
Migraines may continue beyond menopause
Menopause most often happens after age 45, and it is also when the ovaries stop producing estrogen and progesterone. The gradual depletion of hormone levels not only causes infrequent periods, but it can also cause recurrent and longer-lasting migraines.
Vincent Martin, MD, professor and director of the Headache & Facial Pain Program at the University of Cincinnati College of Medicine, says that following menopause, “female hormones are falling and this can either drastically improve or sometimes worsen migraine attacks.”
Birth control and period headaches
Since birth control pills are comprised of estrogen or a combination of estrogen and progesterone, they have a direct influence on natural hormone levels. For some, this means that birth control pills can stabilize or improve a variety of symptoms associated with periods. But, others find that headaches are a common side-effect of birth control pills.
“Birth control pills can worsen headaches in some girls or women because estrogen levels plummet during the placebo week of the birth control pills, which can trigger migraine attacks. One strategy to manage this is to use extended duration birth control pills that only give a placebo week every 3 months instead of monthly,” Martin tells Insider.
Also, birth control pills are not recommended for people with migraines with aura. According to The Migraine Trust, there is a small risk of ischemic stroke when you have migraine with aura while taking birth control pills — because of that higher level of systemic estrogen. If you have migraines associated with your period, but do not experience auras, speak to your doctor to discuss the risks and benefits of trialing a birth control pill.
Fortunately, not all hormonal medications are triggering. Hormone replacement therapy (HRT) is often used to relieve symptoms of menopause, such as hot flashes and vaginal dryness. When taken via gel or estrogen patches, hormone replacement therapy can reduce migraines by maintaining stable estrogen levels. And unlike birth control pills, hormone therapy may be safer to use for women who have migraine with aura. There are many other side effects to HRT that must be considered prior to initiating this treatment, and the use is generally most accepted in post-menopausal women.
How to identify a period headache
Migraines are easily misdiagnosed as a common headache. Because of this, the American Migraine Foundation reports that less than 5% of migraines are seen, diagnosed, and appropriately treated by a health care provider. Here are some ways to identify menstrual migraines.
Pavlovic emphasizes that migraines are more severe than the common headache. It’s a chronic neurological disorder. “Though headache is generally the most disabling symptom of migraine, migraines are disorders of brain hyperexcitability that encompasses many other features,” she says.
Unlike migraines, headaches cause throbbing pressure that differs in intensity based on where the pain is on your head. The average headache goes away by itself and may last from 30 minutes to a couple of hours. This is a short amount of time compared to menstrual migraines, which can last for days.
Migraines may also be thought of as a PMS symptom. However, menstrual migraines have more severe symptoms that set them apart from the average period. Pavlovic says difficulty sleeping is also associated with menstrual migraines.
A 2014 review found migraines can cause sensory hypersensitivity. This includes a heightened reaction towards a variety of senses, including light and sound. You’ll know if you have an extreme sensitivity towards light (photophobia) if natural or indoor lighting causes irritation to your eye and worsens your migraine. A heightened sense of sound (phonophobia) and discomfort of sounds at average volume can also be a sign of a migraine attack.
Sensitivity to movement, including vertigo and balance issues, is another notable symptom of menstrual migraine. Johns Hopkins Medicine reports women are more vulnerable to this symptom around the time of their period.
Common migraine triggers to avoid
There are specific triggers that can bring on migraine attacks. An important one, says Martin, is stress. “Women might be more vulnerable to stress with the hormonal changes that occur during the last week of the menstrual cycle right before the onset of the menstrual period,” she says.
Other triggers include alcohol and trouble sleeping. “Some types of alcohol, like wine and sleep dysregulation, are known as migraine triggers. When hormones are fluctuating prior to menstruation, and there is an increased chance of migraine, presence of other known triggers such as alcohol or sleep disruption generally worsens things,” Pavlovic tells Insider.
Food containing the flavor enhancer MSG and nitrite may also worsen migraines, says Martin. Consuming food with MSG has been linked to cramps, diarrhea, and a painful migraine in 10% to 15% of people with recurring migraines.
Nitrates, found in processed meats and some leafy vegetables, are converted to nitrites by bacteria and eventually into nitric oxide that travels in the bloodstream. A 2016 study found that people had recurring migraines due to nitrate-rich food.
How to treat a migraine
While birth control can disrupt natural estrogen and progesterone levels, it does help in planning your period. This can be a strategy to prevent migraines, suggests Martin.
Another useful treatment is triptans. “You can take a medication called a triptan for 4-5 consecutive days starting 1-2 days before the day that you expect the period headache to start and ending 4-5 days later. This can help you prevent the period headache by treating the headache before it even begins,” says Martin.
According to the American Migraine Foundation, taking triptans such as sumatriptan, rizatriptan, zolmitriptan, almotriptan, or eletriptan in combination with NSAIDs such as naproxen or ibuprofen early on in the migraine attack can help to relieve painful symptoms.
NSAIDs such as 550 mg of naproxen can also be taken separately. When NSAIDs are taken twice a day around the 5-7 days surrounding your menstrual migraine window, i.e. 2 days before the start of your period and 3 days after, it can help prevent migraines or cause it to be less severe.
Magnesium supplements can also help manage migraine pain, says Pavlovic. Low levels of magnesium have been reported with increased migraines, per the American Migraine Foundation. Taking a daily oral dose of 400-500 mg of magnesium oxide is a preventable method that’s also safe during pregnancy. And because of magnesium’s ability to prevent heightened sensory changes in the brain, it has also been effective in migraines with aura.
The Mayo Clinic also recommends alleviating migraine pain by placing ice packs wrapped in a towel on painful areas.
Martin suggests lifestyle changes such as eating a healthy diet and weight loss are important in preventing menstrual migraines. Avoid migraine triggering food and drink 1.5 to 2 liters of water every day. Establishing a consistent sleep schedule is also crucial.
Menstrual migraines are not your regular headache nor just another period symptom. They are a chronic disorder caused by fluctuations in estrogen and progesterone. While menstrual migraines can continue even after your period is gone, some treatments can help eliminate or, at best, manage the most severe symptoms.
To ensure proper treatment, Pavlovic says it’s important to keep track of menstrual migraines.
“Recognizing the time when their migraine is most likely to occur is essential,” says Pavlovic. “Keeping a headache diary and discussing the information from several months of the diary with their doctor to recognize times of increased risk of headache can make a key difference in headache treatment and, therefore, overall health.”