Living with menstrual migraines: Symptoms, triggers and strategies for relief

If you’ve noticed you tend to get headaches more at a certain time of the month, it could be migraines related to your menstrual cycle. About 1 in 4 women who have migraines also have menstrual migraines. In the general population, as many as 8% of women have this menstrual-related condition.  

Because periods can bring a range of symptoms, it’s common for women to think menstrual migraines are just another thing they have to deal with. But by paying attention to your body and bringing up your symptoms to a healthcare provider, you can find treatment strategies that actually work for you.

Causes and triggers of menstrual migraines

Our sex hormones have a large influence on our brains, including the likelihood of migraines or headaches. As kids, boys and girls have about the same rates of migraine. But when girls hit puberty, they take over by large numbers. Women are two to three times more likely than men to have migraines.

One common thought is that these migraines are triggered by the cycle of estrogen levels every month. Estrogen rises to prep for ovulation during the first half of the cycle and then drops. This estrogen withdrawal is the main trigger of menstrual migraine.

There are also pro-inflammatory compounds released during menstruation, called prostaglandins, that could contribute to increased pain. Doctors think that the trigeminal nerve, which is the facial nerve related to migraine pain, is more sensitive during this time. And decreased serotonin, which impacts the blood vessels of the brain, could also contribute.

What are the symptoms of menstrual migraines?

Menstrual migraines have many of the same symptoms as migraines in general. These migraines happen either within two days before the first day of bleeding or three days after bleeding has started—at least two out of three cycles. Menstrual migraines may be more difficult to manage or more severe than other migraines.

Some signs that your headache might be a migraine include:

• Nausea
• Light and sound sensitivity
• One-sided pulsating
• Moderate to severe intensity
• Worse with activity or movement

Migraines might also cause symptoms like smell sensitivity, brain fog or mood changes.

Diagnosis and testing

If you think you might be having headaches or migraines related to your menstrual cycle, it’s important to talk to a healthcare provider and get the right diagnosis. Some different types include:

• Pure menstrual migraine—meaning headaches only happen around your period.
• Menstrually related migraine—which means that you have migraines both during this time and outside of this time.
• Tension headaches—which can increase around your menstrual cycle but are not migraines.

The diagnosis of menstrual migraines is typically based on your health history and a physical exam. Because everyone is different, many people find it helpful to use apps to track symptoms, triggers and patterns. If you’re having very severe symptoms or any red flags, your doctor might also order additional testing.

Treatment options for menstrual migraines

Once you have a diagnosis, you can work with your provider to create a plan. Often, lifestyle changes are the best first step and remain important even if your doctor recommends medications. You may need a combination of treatments to help you manage your menstrual migraines.

Medication therapy

Medication therapy for menstrual migraines falls into two main groups: reactive medications that you take when you already have a migraine and preventive medications that you take before a migraine happens.

For pure menstrual migraine—the kind that only happens during your cycle—you may try typical migraine rescue medications. These include anti-inflammatories, triptans, CGRP inhibitors or dihydroergotamine.

Preventive medications are also an option, such as longer-acting triptans or CGRP inhibitors. These medications are taken on a scheduled basis, starting about one or two days before your headache usually starts and continuing for four or five days.

Lifestyle changes

With menstrual migraine, it often helps to make similar lifestyle changes as someone with any type of migraine. The brain doesn’t like change, so consistency in your lifestyle and routine can help avoid triggers.

Lifestyle changes might include:

• Waking up and going to bed at the same time and getting good rest
• Addressing any increased stress with options like meditation, yoga or mindfulness
• Eating a balanced diet
• Staying hydrated and not skipping meals
• Regular exercise—even just 30 minutes of walking a day

Symptom management

If you do develop a menstrual migraine, you can often take other steps along with traditional medications to manage your symptoms. Some examples include:

• Anti-nausea medications if you have nausea with your migraine
• Ice packs or pressure, including migraine caps designed specifically to provide cold pressure during a migraine
• Finding a quiet, comfortable environment
• Smelling essential oils or placing them on the back of your neck

Hormonal therapies 

Hormonal therapies can help reduce menstrual migraines that are triggered due to the rapid drop of estrogen during your cycle. But there are a lot of factors that go into choosing the right hormonal therapy for you—from personal preferences to risk factors.

Talk to your women’s health provider about therapies like continuous oral contraception. With this option, you take active pills the entire month, keeping estrogen levels more stable.

Alternative therapies

A couple of supplements have some evidence that they could be helpful with migraines. Ask your doctor about trying magnesium or vitamin E. You can take these supplements in a pattern that follows your menstrual migraines—before or during your period. 

Living with menstrual migraines

Because many different types of changes in your hormones affect migraines, you may find that living with this condition requires ongoing care that evolves along with you. From your menstrual cycle to pregnancy to menopause, your migraine symptoms may change over time.

For example, 80% of women experience improvement of migraines in the second and third trimesters of pregnancy. During perimenopause, fluctuations in estrogen levels often worsen migraine or even cause new migraines. And once women reach menopause, it’s estimated that 20-50% see their symptoms get better.

Even with these ups and downs, a consistent, personalized plan can help you proactively manage migraines for the long term. Options like the Virtual Headache Care program through Baylor Scott & White Health can give you a simple way to connect with the ongoing care you need.

When to seek medical care

Migraines can make you miss out on work, spending time with family or friends, or doing things that you like. If you find yourself worrying about a migraine happening or adjusting your life to fit your migraines, it’s time to seek care.

There are also signs that you should see a healthcare provider sooner rather than later. You may need urgent care for symptoms like:

• New headache over age 50
• Rapid, severe pain that comes on within minutes
• Severe headache that’s waking you up at night
• Neurologic symptoms like vision changes, trouble speaking, numbness, weakness or trouble with balance
• A sudden change in the severity and frequency of your headaches

Are menstrual migraines connected to other health conditions?

One other important thing to consider when it comes to menstrual migraines is how they connect to other medical conditions. Menstrual migraines are more common in women who have heavy or painful periods—called menorrhagia—as well as those with polycystic ovary syndrome (PCOS).

Migraines overall may be related to conditions such as sleep apnea, sleep disorders, anxiety, depression, mood disorders, epilepsy, high blood pressure or even irritable bowel syndrome.

Menstrual migraine care that fits your life

If you’re living with migraines or headaches that seem to follow your monthly cycle, now is the time to do something about it. Severe, disabling headaches around your period aren’t an inevitable part of your month.

As a woman, you balance a lot of priorities, but taking time to talk about menstrual migraines and care for yourself is worth it. With personalized support, you can fit the migraine care you need into your life.

Start your headache relief journey today by connecting with a headache care specialist through the Virtual Headache Care program.