Menstrual Migraines (Hormone Headaches)
What’s a migraine? What does it feel like?
A migraine is more than a bad headache. It’s a neurologic disease with a series of symptoms that might include debilitating pain on one side of your head that you may describe as pulsing or throbbing. Menstrual migraines, also known as hormone headaches, happen right before or during a woman’s period (up to two days before through three days during) and may get worse with movement, light, smells, or sound. Your symptoms may last for a few hours, but they’ll likely last days.
It’s estimated that 70% of people who experience migraines are women. Of these women, 60% to 70% report a connection between their menstruation (periods) and their migraine attacks. Women experience migraine attacks three times more frequently than men.
A menstrual migraine is one of several types of migraine headaches. Examples of other migraines include migraine with aura, migraine without aura and chronic migraine.
What are hormones? What is estrogen?
Hormones are often called your body’s “chemical messengers.” They’re in your organs, tissues and bloodstream and they’re 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. It’s mostly produced by your ovaries.
Your levels of estrogen change. They’re at the highest amount in the middle of your cycle and the lowest amount when you’re on your period. When you’re in menopause, they drop very low.
What’s the relationship between hormones and headaches?
Headaches in women, especially migraines, are related to changes in the levels of estrogen. Levels of estrogen drop immediately before the start of your 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 improve during pregnancy. However, some women have reported that their migraines started during the first trimester of pregnancy, and then went away.
What’s the difference between menstrual migraines and other types of migraines?
Menstrual migraines are triggered by a drop in estrogen. Other migraines may be triggered by stress, missing a meal, caffeine, or many other reasons.
How common are menstrual migraines?
About 12% of Americans experience migraines. The majority are women, at least 60% of those women have observed a correlation between their menstrual cycle and their migraines. In other words, they’ve noticed that they get a migraine right before or during their period.
When do menstrual migraines start?
Menstrual migraines can start up to three days before your period.
Who is more likely to get a menstrual migraine?
While migraines can start when you’re a child, menstrual migraines don’t until your periods begin. Women who have periods are the ones who get menstrual migraines.
Symptoms and Causes
What causes menstrual migraines?
Changes in estrogen levels, which happen right before your period begins.
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 are the symptoms of a menstrual migraine?
The symptoms of a menstrual migraine are the same as the symptoms for other types of migraines:
- Headache pain that ranges from dull to a severe throb.
- Feeling very warm (sweating) or cold (chills).
- Sensitivity to light, noise and smells.
- Tender scalp.
- Loss of appetite.
- Dizziness and blurred vision.
- Pale skin color (pallor).
- Feeling tired.
- Nausea and vomiting, stomach upset, abdominal pain.
- Diarrhea or fever (rare).
Diagnosis and Tests
How’s 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 (such as a CT scan or MRI) to make sure there are no other causes for your headache. An electroencephalogram (EEG) may be ordered to rule out seizures.
It’s 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.
Management and Treatment
How are menstrual migraines treated? What medicines can I use?
A 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 your period starts, and continue through your menstrual flow. Because the medication is taken for a short time only, the risk of gastrointestinal side effects is limited.
Triptans – selective serotonin receptor agonists – are medicines used for acute migraines. They stop your menstrual migraine after it begins. In the United States there are seven triptan medications approved for use:
- Almotriptan (Axert®).
- Eletriptan (Relpax®).
- Frovatriptan (Frova®).
- Naratriptan (Amerge®).
- Rizatriptan (Maxlt®).
- Sumatriptan (Imitrex®).
- Zolmitriptan (Zomig®).
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 topiramate.
- Calcium channel blockers such as verapamil.
- Estrogen patch, gel, or pills.
- Contraceptives, which may reduce the number of menstrual migraines.
- Dihydroergotamines (DHE).
These drugs should also be started two to three days before your period starts. Continue taking them throughout your menstrual flow.
Because fluid retention (retaining water) often occurs at the same time as your menses, diuretics have been used to prevent menstrual migraines. Some healthcare providers may recommend that you follow a low-salt diet immediately before the start of your menses.
Leuprolide (Lupron®) is a medication that affects your hormone levels. It’s used only when all other treatment methods have been tried and haven’t worked.
Are there side effects of the medications?
Talk with your healthcare provider and pharmacist about the side effects of each medication prescribed. The most common side effects of medications prescribed to fight migraines include:
- Loss of strength (weakness).
- Pain, pressure, or heaviness in your chest.
- Dry Mouth.
- Headache (other than the migraine).
- Burning or prickly feeling, numbness, or tingling.
- Sensation of warmth or coldness.
Do I need to see a specialist?
Ask your primary healthcare provider to refer you to a headache specialist.
What are the treatment options for menopausal migraines?
If you need to continue estrogen supplements after menopause, you should start on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, you may be told to 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 migraines during pregnancy?
Because most medications taken for migraines can affect your baby, you should avoid them. However, your healthcare provider may give you permission to take a mild pain reliever like acetaminophen. Talk to your healthcare provider before you take any medicine.
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 can’t.
Can menstrual migraines be prevented? What medications can I take?
Your healthcare provider may prescribe preventative medications that you take daily, then increase the dose when you’re near your period. Possibilities include:
- NSAIDs like naproxen sodium.
- Estradiol (estrogen hormonal therapy).
Outlook / Prognosis
Do menstrual migraines cause any brain damage?
No type of migraine causes brain damage.
How long will I have menstrual migraines?
You may have menstrual migraines until you’re in menopause.
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.
- You’re experiencing new or different side effects.
- Your medications no longer seem to be working.
Call 911 or go immediately to an Emergency Room if:
- 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.
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 I’m 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 they’re 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.
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