What Is A Menstrual Migraine?

'Understanding The Likely Timing Can Only Help So Much.....'

By Definition –

A menstrual migraine is defined as a migraine that starts 2 days before your period and ends up to 3 days afterwards.

It is different to a normal migraine that is occasionally triggered by your period because menstrual migraines much more consistently fall on your period – so much so that they can be considered to be directly caused by your period.

In this article we explain more about what is a menstrual migraine and what you can do about them…

What Is A Menstrual Migraine?

A menstrual migraine is no normal migraine. And it requires both different migraine preparation and a different migraine treatment.

Unlike other migraines with multiple triggers, a menstrual migraine is only triggered by your period – and occurs like clockwork on a monthly basis.

Unfortunately, with menstrual migraines, while the trigger may be obvious, there is little you can do to avoid it (other than various forms of HRT to prevent/ stop your period altogether).

Contrary to what some people believe, it is not actually your menstruation itself or even the changing hormone levels that cause menstrual migraines.

It is actually the fact that your hormones are changing and the stress this change has on your body that creates the migraine, rather than the hormones themselves.

Therefore the greater your hormonal changes, the greater the stress, the stronger the migraine.

For those who do suffer, the National Migraine Centre notes that menstrual attacks are

“typically more severe, last longer, and are more likely to recur the next day than non-menstrual attacks” 

Luckily, it is not thought to affect more than 10% of women going through monthly menstruation. Not so lucky however, if you are one of those 10%.

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Causes Of Menstrual Migraines

Somewhat obviously, the single cause of menstrual migraines is your menstruation itself.

There are two main, commonly accepted ideas as to why a menstrual migraine may occur, both relating to key changes in your hormones during your period –

1) Prostaglandin Changes.

The first is an increase in prostaglandin during those first important 48 hours of your menstruation.

2) Oestrogen Changes.

The second is thought to be down to a fall in oestrogen levels as a natural part of your cycle. (Somerville BW

There are also certain outside considerations that can cause or affect you menstrual migraines –

3) Birth Control.

The pill can actively make menstrual migraines worse. This is because while it controls your hormones for 3 weeks of the monthly cycle, during your period when you don’t take them, is likely to see an even bigger swing to lower amounts of oestrogen.

4) Hormone Replacement Therapy.

Medicine of this nature, designed to control hormones, can again result in swings that cause migraines.

Oestrogen patches have been used as an alternative that offers a more steady, less fluctuating dose in to your body.

Menstrual Migraines and The Menopause.

Theoretically, stopping periods altogether should result in substantially less migraines, due to less hormonal swings.
However, a lot of this will depend on the amount and effectiveness of any replacement therapy.

Diagnosis of Menstrual Migraines

Even though these are hormonal changes, there is actually no easy method to measure such occurrences.

This means confirming if you are suffering from a regular menstrual migraine relies on an accurate migraine diary – recording what stages of your cycle you are at every time you feel the first symptoms of a migraine.

If you look back over a period of a minimum of three months and you find that you are consistently suffering migraines somewhere in the period from 2 days before you period started to 3 days afterwards, then your period is most likely the trigger.

Treating Menstrual Migraines

Once you have confirmed your migraines as being menstrual migraines, then you can at least estimate fairly well when each one is most likely to hit you. This gives you the ability to avoid all other possible triggers in the lead up.

And while avoiding other triggers is unlikely to prevent a menstrual migraine altogether, making sure you miss other potential triggers in the build up will help to at least lessen your migraine’s duration and severity.

In practical terms this means not getting tired in the days before your period, keeping your sugar levels consistent by eating small, consistent meals and maybe even giving up alcohol (permanently).

Unfortunately, if the real cause is purely based around your cycle, then you’ll potentially also need to consider more specific treatments aimed at preventing or re-balancing your cycle.

These are likely to be medicinal in substance and will require considerable consultation with your doctor to make sure you get the right mix and keep monitoring the doses/ responsiveness to achieve optimum results.

The sort of options they might consider are not licensed directly for a menstrual migraine, but will alter your bodies hormonal balance at the critical times. However, they will need to know just how regular your periods are and how heavy they are typically.

If your periods are heavy, then they may consider an anti-inflammatory painkiller such as Naproxen or Mefenamic Acid to be taken specifically around the time of menstruation.

Alternatively, you could consider looking at oestrogen supplements. This will help greatly if your migraines are tied in to falling oestrogen levels during your period.

Oestrogen supplements can be purchased as patches or a gel that absorbs in to your body.

The final option is some sort of contraceptive device or pill that will actually stop your periods from happening. This again should stop the hormone fluctuations and in turn help to prevent your migraine.

The irony however, is that as mentioned above, taking a combined hormonal contractive (CHC) such as the pill, is likely to both prevent some migraines, but actually make menstrual migraines worse as the ‘off-time’ makes the hormonal swings even greater.

Another option here may be the progesterone-only pill (Cerazette) as this can be taken every day and doesn’t affect oestrogen levels. Cerazette as a brand has particularly unique claims to switch off your cycle, and hence menstrual migraines.

You have to consider however, what longer term goals you have, particularly with reference to childbirth as your consultant will need to take these into consideration as well, when deciding on the right medications.


As mentioned above, of the current medications, Mefenamic Acid or Naproxen have been found to be effective with at least partial prevention of menstrual migraines.

Mefenamic acid in particular has been considered to be effective for migraines associated with painful or heavy periods and has worked with menstrual migraines, although no direct data currently exists to back this up.

Would Having A Hysterectomy Help To Prevent A Menstrual Migraine?

With the increase in understanding around various overian cancers and issues going through ‘the change’, a hysterectomy is increasingly becoming a choice.

However, it is the ovaries themselves that stimulate the various hormonal changes during a period and that ultimately trigger a migraine.

As a result, a hysterectomy wouldn’t actually address removal of the ovaries unless it was specified and agreed with the doctor as an extra procedure.

‘A hysterectomy on its own will only remove the uterus, so in isolation it wont help at all.’

However, if the ovaries are taken out of action either by surgery or other treatment, then HRT (hormone replacement therapy) will have an impact on keeping oestrogen production at a high level. This is turn is likely to prevent a menstrual migraine.

The Final Word –

Hopefully now you know what is a menstrual migraine and what options you have available for lessening their impact.

Without knowing what they are, makes them a particularly violent and depressing form of migraine. So a good understanding and a close relationship with your consultant is essential to moving forward.

The single advantage of understanding what is a menstrual migraine is that you can at least take steps to prepare for it’s arrival.

Sensible preparation as detailed above can, if nothing else, help to lessen the severity of the menstrual migraine when it comes.

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References –

1. B W Somerville. (April 1972). The Role of Estradiol Withdrawal in the Etiology of Menstrual Migraine. Neurology.

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