It has been estimated that 70% of migraine sufferers are women. Of these migraine sufferers, 60% to 70% report a connection between their menstruation (periods) and their migraine attacks.

What is the relationship between hormones and headaches?

Headaches in women, especially migraines, have been found to be related to changes in the levels of estrogen (a female hormone) during a woman’s menstrual cycle. Levels of estrogen drop immediately before the start of the menstrual flow (menses).

Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, drop to their lowest levels.

Migraine attacks usually disappear during pregnancy. However, some women have reported that migraines started during the first trimester of pregnancy, and then went away after the third month of pregnancy.

What triggers migraines in women?

Birth control pills, and hormone replacement therapy for menopause, can change the frequency or severity of headaches. If you notice your headache getting worse after starting one of these medications, it may be worthwhile to ask your physician 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 are the treatment options for menstrual migraine?

Menstrual migraine is usually treated with nonsteroidal anti-inflammatory medications (NSAIDs). The NSAIDS most often used for menstrual migraine include:

  • Ketoprofen (Orudis®)
  • Ibuprofen (Advil® and Motrin®)
  • Fenoprofen calcium (Nalfon®)
  • Naproxen (Naprosyn®)
  • Nabumetone (Relafen®)

Treatment with the NSAID should begin two to three days before the period starts, and continued through the menstrual flow. Because the medication is taken for a short time only, the risk of gastrointestinal side effects is limited.

Other medications that might be prescribed include:

  • Small doses of ergotamine (including Bellergal-S®) or a similar compound, methylergonovine maleate (for example, Methergine®)
  • Beta blocker drugs such as propranolol
  • Anticonvulsants such as valporate
  • Calcium channel blockers such as verapamil

These drugs should also be started two to three days before the period starts and continued throughout the menstrual flow.

Because fluid retention (retaining water) often occurs at the same time as menses, diuretics have been used to prevent menstrual migraine. Some physicians may recommend that the patient follow a low-salt diet immediately before the start of menses.

Leuprolide (Lupron®) is a medication that affects hormone levels. It is used only when all other treatment methods have been tried and have not worked.

What are the treatment options for menopausal migraine?

If a patient needs to continue estrogen supplements after menopause, she should be started on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, the patient should take it every day. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm®) may be effective in stabilizing the levels of estrogen.

What are the treatment options for migraine during pregnancy?

During pregnancy, no treatment is recommended for migraines. Medication that is used to treat migraines can cross the placenta and affect the baby, so these medications should be strictly avoided.

A mild pain-reliever, such as acetaminophen, can be used for migraines. It’s important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/14/2016...#8260