Why You Get Migraines During Your Period and How to Prevent Them
Period or menstrual migraines are triggered by hormonal changes. Learn more about the causes, symptoms, and treatment options to help you cope.
The menstrual migraine double whammy
Nobody will tell you premenstrual syndrome is breeze. (And if they do, they’ve probably never experienced it.) As if PMS wasn’t unpleasant enough, you may also deal with migraines during your menstrual cycle.
“Migraines are often a hereditary disorder, and there’s a major hormonal influence on them,” says Mary O’Neal, MD, director of the women’s neurology program at Brigham and Women’s Hospital in Boston.
In essence, a migraine is a pain disorder related to abnormal connectivity in the brain. It all starts, experts think, via “an abnormal electrical discharge in the brain that triggers downstream effects to activate the trigeminal vasculature,” she says.
In other words, nerves from the brain stem activate blood vessels around the brain, which in turn cause blood vessel changes and trigger a type of inflammation not associated with infection. The end result: you feel a whole lot of pain.
Several different migraine triggers may start this process, including poor sleep habits, caffeine use, certain foods, and weather changes.
Hormonal fluctuations associated with menstruation is among those possible causes. And it’s a very common one.
In fact, 60 percent of women who get migraines have menstrual migraines, according to the National Headache Foundation.
What are period migraines exactly?
Migraines are three times more common in women than men, according to the Migraine Research Foundation. That’s due, in large part, to hormonal influences, Dr. O’Neal explains.
So it’s no surprise that many women have menstrual-related migraines, which simply means that menstruation is one of the triggers for their migraines. Another name for this condition: hormone headaches.
Some people who get periods also have menstrual-only migraines, meaning they only get migraines around their period.
What causes period migraines?
Changes in estrogen levels can trigger migraines.
For some, increases in estrogen around ovulation can tip off head pain, but usually, it’s the decrease in estrogen during menses that prompts a migraine, Dr. O’Neal says.
Migraines also may become more frequent during other times of hormonal change.
These include your first trimester of pregnancy, when estrogen quickly rises; during the postpartum period, when hormones are shifting back to prepregnancy status; and during menopause, when estrogen is decreasing.
Signs you’re having a period migraine
Migraines can happen predictably, especially if you’re prone to having them before, during, or after your period.
You may get a migraine a day or two before you start to bleed. You may also get a migraine during the duration of your period. Or you might get one right after or during ovulation.
Certain signs make it easier to tell whether your migraine is happening in connection with your cycle. Here’s what to look for:
A migraine that starts before your period is known as a PMS migraine. It usually occurs in conjunction with other PMS symptoms. Some common symptoms include:
- Joint pain
- Head pain
- Increase in appetite and cravings for salt, chocolate, and alcohol
Symptoms of a period migraine are similar to those of a regular migraine. These include:
- Throbbing or pulsating pain on one or both sides of the head
- Sensitivity to light, noise, or smell
- Aura (seeing flashing or zigzag lights or black spots prior to headache), but this isn’t too common
Check out these signs you’re having a silent migraine.
How to treat period migraines
First, consider the most important question: are you having migraines only around your period, or do they happen at other times of the month too? Your answer will determine the best treatment option for you.
Here, our experts share some tips to help alleviate period migraine symptoms.
Use over-the-counter (OTC) medication to treat symptoms if you have migraines no more than two times per month, says Dr. O’Neal.
For example, take a pill that combines aspirin, acetaminophen, and caffeine (like Excedrin) right away to stop a migraine when it starts.
If that doesn’t work, talk with your doctor about taking these medications ahead of time to prevent a period migraine.
This works best “if you have a regular menstrual period and can identify when you get a migraine,” says Dr. O’Neal.
Maybe, like clockwork, you get a migraine two days before the first day of your period. You can take your OTC medication before it starts to lessen the severity of your symptoms.
Like Excedrin, nonsteroidal anti-inflammatory drug (NSAID) like naproxen and ibuprofen can be taken two to three days before the time of month you usually get a migraine.
Of course, this trick won’t work if your period is unpredictable.
Your doctor may also talk to you about a class of migraine-stopping medications called triptans. They have longer-acting formulas, which can be used before menstruation.
“These prevent the vascular changes that occur with a migraine,” Dr. O’Neal explains.
Hormonal contraception—aka the birth control pill—is an option too.
“In our headache practice, we do a lot of contraceptive management for pain,” says Chaouki K. Khoury, MD, a neurologist with Panda Neurology and Atlanta Headache Specialists.
This can be done in a few ways, he says:
Low-dose estrogen pill
This will diminish the drop in estrogen.
Two prescriptions for oral hormonal birth control
If your doctor prescribed this route, you would take a combination pill that has a higher amount of estrogen for 21 days.
During the seven days of placebo pills, you’d discard the placebos and take a low-dose estrogen pill instead. This method decreases the fluctuation in estrogen throughout the month.
Insurance usually doesn’t cover two prescriptions, says Dr. Khoury. But considering the pain of migraines, his patients are often comfortable paying for the second prescription out of pocket—especially if it works for them.
A 21-day prescription of the low-dose estrogen pill will last three months with this method.
Continuous oral contraception
Combined levonorgestrel with ethinyl estradiol (Seasonique or Lybrel) where you don’t have a placebo week and therefore do not get a period allows you to get your period once every three months—or not at all. Usually, there are no swings in estrogen and no menstrual migraines, says Dr. Khoury.
If your period is just one trigger for your migraines and you have regular attacks (such as more than one per week), consider a preventive medication.
The problem with using OTC pain relievers or triptans to repeatedly treat migraines is that you can develop medication overuse headaches. That happens when the medication is actually triggering your migraine.
The right preventive migraine medication for you depends on a variety of factors, like your health history and other medical conditions, treatments you’ve tried already, and tolerability of side effects.
Here are some options your doctor may suggest:
- Blood pressure medications, such as beta-blockers and calcium channel blockers
- Serotonin antagonists
The ultimate goal is either to decrease the number of headaches you have in a month or to decrease their intensity so they’re easier to live with.
Sometimes, says Dr. O’Neal, a preventive drug will work throughout the month but not when it comes to menstrual headaches.
If that’s the case, your neurologist might consider increasing it before your period to see if that can prevent the episode.
How to prevent menstrual migraines
Treatment and prevention go hand in hand when you’re talking about period migraines.
A headache diary can be helpful for tracking when you get a migraine and where it falls in relation to your cycle.
Armed with that information, you can act by either stepping in with a migraine-stopping medication (like an NSAID or triptan) in the days before your expected migraine, take a migraine preventive medication, or start hormonal birth control.
For example, if you know that changes to your sleeping habits set off an attack, make a plan to prioritize a regular sleep schedule—and stick to it.
If you know that missing a meal leads to a migraine (and an irritable mood), be sure to eat at the same time each day and keep healthy, nourishing snacks on hand.
How to find the right care
Migraines can be challenging to treat. For the best care, see a migraine or headache specialist. This person is often a neurologist.
You can find one in your area by using the American Migraine Foundations’ Find a Doctor tool.
Some practices are also continuing virtual care, so you may be able to visit with a doctor who’s further away from where you live.
In that case, your primary care physician may be able to work with the migraine specialist while remaining involved in your care.
- Mary O'Neal, MD, director of the women's neurology program at Brigham and Women's Hospital in Boston
- Chaouki K. Khoury, MD, neurologist at Panda Neurology and Atlanta Headache Specialists
- Migraine Research Foundation: "Migraine is a women's health issue"
- American Migraine Foundation: "Understanding Migraine with Aura"
- American Migraine Foundation: "What Is Migraine?"
- American Migraine Foundation: "Preventive Treatments"
- National Headache Foundation: "Menstrual Migraine"