Menstrual Migraines (Hormone Headaches)

What is a period headache?

Period headaches are a common type of migraine that happens around the time of your menstrual cycle. Hormonal changes cause these migraine headaches.

A period headache is usually one-sided. It may get worse with movement, light, smells or sounds. Your symptoms can last for a few hours, but they’ll likely last days.

You might hear your healthcare provider refer to a period headache as:

• Menstrual migraines (menstrually related migraines).
• Hormone headaches (hormonal headaches, hormonally related headaches).
• Period migraines.
• Hormonal migraines.

What’s the relationship between hormones and headaches?

Period headaches relate to changes in estrogen levels. Levels of estrogen drop immediately before the start of your menstrual flow (menses).

Premenstrual migraines regularly occur during or after the time when the hormones, estrogen and progesterone, drop to their lowest levels. Significant changes to your hormones can influence headaches.

What does a hormone headache feel like?

You might notice that period headaches are more severe than other headaches you experience. Many people report head pain that is pulsing or throbbing.

How common is a period headache?

About 12% of Americans experience migraines. At least 60% of people who have a period and experience migraines report migraines happening around the time of their menstrual cycle.

What are the symptoms of a period headache?

The symptoms of a menstrual migraine include:

• Head pain that ranges from dull to severe.
• Sensitivity to light, sound and smells.
• Tender or sore scalp.
• Loss of appetite.
• Dizziness.
• Blurred vision.
• Feeling tired.
• Nausea and vomiting, upset stomach, abdominal pain.
• Feeling very warm (sweating) or cold (chills).

Where are menstrual headaches located?

Head pain associated with a period headache usually affects one side of your head. It’s common to feel pain around your forehead, but it can also happen in other locations or move from one spot to another area. These headaches are slightly different for each person.

When do period headaches start?

Menstrual migraines can start up to two days before your period and last for three days during your period.

Why do I get headaches with my period?

A change in your hormone levels causes period headaches.

Estrogen is one of two main sex hormones. Your levels of estrogen change. They’re at the highest amount in the middle of your menstrual cycle and the lowest amount when you’re on your period. The drastic change in your hormones makes headaches more likely to happen because estrogen increases your pain sensitivity.

What triggers period headaches?

Hormonal fluctuations, most often estrogen, trigger period headaches. You might notice more frequent or severe migraines when taking certain medications that affect your hormones like:

• Birth control pills.
• Hormone replacement therapy.

If you notice migraine headaches getting worse after starting one of these medications, talk to your healthcare provider. They might recommend a different medication that contains a lower dose of estrogen or switch you from an interrupted dosing regimen to a continuous one.

What are the risk factors for a period headache?

If you have a period, you’re at risk for menstrual headaches. If you get migraines outside of your menstrual cycle or you have a genetic predisposition (family history) of migraines, you’re also at a higher risk.

What are the complications of a period headache?

Period headaches can interrupt your routine. You might not feel well enough to participate in your regular activities or function at 100% when you’re in pain. Unlike a traditional migraine, you can predict when these headaches will occur, but you might notice planning your life around these interruptions. A healthcare provider can help you manage period headaches so they don’t take over.

How is a period headache diagnosed?

A healthcare provider will diagnose a period headache after an exam and testing to rule out conditions with similar symptoms. During the exam, your provider will want to learn more about your migraine-related symptoms. They may ask you the following questions:

• Can you describe the severity and location of your pain?
• Is the pain pounding? Pulsing? Throbbing?
• Can you tell me how often you get migraine headaches?
• Does anything make 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 situations that may have brought on the migraine.
• Do you know if anyone in your family gets migraine headaches?
• How did you feel before, during and after the headache?

Your healthcare provider may also order blood tests and imaging tests (such as a CT scan or MRI) to make sure there aren’t any other causes of your headache.

It’s helpful to both you and your healthcare provider if you keep a migraine journal. This is a record of your headache symptoms. Take note of what symptoms you get, how long your symptoms last and what makes your menstrual migraine better or worse.

Do I need to see a specialist for period headaches?

If you get regular headaches during your period, start by speaking with a primary care physician. They may refer you to a headache specialist.

How are period headaches treated?

Medications are usually the treatment of choice for menstrual migraines. Some of the most common medications a healthcare provider may recommend include:

• Oral birth control pills: If you currently take oral contraceptives, a healthcare provider may change the type or dosage to reduce drastic hormone changes around the time of your period.
• Nonsteroidal anti-inflammatory medications (NSAIDs): NSAIDs reduce pain. Your provider may recommend taking NSAIDs two to three days before your period starts and continuing through your menstrual flow.
• Triptans (selective serotonin receptor agonists): Triptans are a common medication to treat migraines. You can take triptans as directed to stop headache pain when symptoms start. These come in oral tablets, injections or nasal sprays.
• Hormone therapy: To regulate hormone changes during your period, estrogen supplements can help balance your hormones. These come in oral medications, vaginal gels or a patch that you can use the week of your period.

The first line of treatment for severe menstrual migraines usually involves the following medications:

• Antiseizure medications (topiramate, valproate).
• Antidepressants (amitriptyline, venlafaxine).
• Antihypertensives (propranolol, candesartan).

Other medications may include:

• Metoclopramide.
• Calcitonin gene-related peptide (CGRP) antagonists.
• Dihydroergotamine.

Your provider might recommend taking supplements like:

• Magnesium oxide (400 milligrams [mg] at bedtime).
• Riboflavin (200 mg two times per day).
• CoQ10 (300 mg in the morning).

A healthcare provider may try one or a combination of different medications to see what works best to treat period headaches. These medications work best when you take them on a schedule. Your provider can help you identify the right time to take these medications to prevent or manage symptoms.

How do you get rid of a period headache without medications?

There are certain things you can do to manage period headaches naturally. This may take some trial and error 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:

• Get enough sleep.
• Eat well-balanced, scheduled meals (don’t skip meals).
• Participate in regular physical activities.
• Manage stress.

Can a period headache be prevented?

A healthcare provider can help you manage and prevent period headaches. While you can’t prevent all headaches, your provider may prescribe preventive medications that you take daily. You may need to increase the dosage as you get closer to your period. Talk to your provider about preventive options for menstrual migraines and they can advise on a treatment schedule that’s right for you.

How long do period headaches last?

You may have menstrual migraines until you’re in menopause. Treatment aims to prevent or reduce how often you have headaches while you have a period.

What’s the outlook for a period headache?

With treatment, many people have a positive outlook for period headaches. There are several types of treatment options available, so a treatment regimen might take a few cycles to get right.

Some medications work best when you take them on a schedule. You may find it easier to manage if you keep a calendar of your cycles, take oral contraceptive medications or use an app on your smartphone to help you track your periods. A healthcare provider will work with you to find the right treatment option for your situation.

When should I see a healthcare provider?

Schedule a visit with a healthcare provider if:

• You get severe headaches with your period.
• The number or severity of your migraines increases, or your headache pattern changes.
• You’re experiencing new or different side effects.
• Medications to treat migraines no longer seem to be working or they affect your quality of life.

Call 911 (or your local emergency services number) or go immediately to an emergency room if:

• A 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’ve never had before, including speaking difficulty, balance problems, vision issues, mental confusion, seizures or numbing/tingling sensations.

What questions should I ask my healthcare provider?

• Am I experiencing a period headache or another type of migraine?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How can I prevent future period headaches?