A menstrual migraine (or hormone headache) starts before or during a woman’s period and can happen every month. Common symptoms include a dull throbbing or severe pulsing headache, sensitivity to light, nausea, fatigue, dizziness and more. There are treatment and prevention options you can try.
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.
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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.
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.
Menstrual migraines are triggered by a drop in estrogen. Other migraines may be triggered by stress, missing a meal, caffeine, or many other reasons.
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.
Menstrual migraines can start up to three days before your period.
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.
Changes in estrogen levels, which happen right before your period begins.
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.
The symptoms of a menstrual migraine are the same as the symptoms for other types of migraines:
Your healthcare provider will want to establish a history of your migraine-related symptoms, likely asking you to:
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.
A menstrual migraine is usually treated with nonsteroidal anti-inflammatory medications (NSAIDs). The NSAIDs most often used for menstrual migraine include:
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:
Other medications that might be prescribed include:
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.
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:
Ask your primary healthcare provider to refer you to a headache specialist.
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.
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.
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:
Your healthcare provider may prescribe preventative medications that you take daily, then increase the dose when you’re near your period. Possibilities include:
No type of migraine causes brain damage.
You may have menstrual migraines until you’re in menopause.
Schedule a visit with your healthcare provider if:
Call 911 or go immediately to an Emergency Room if:
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.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
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