Mass General Hospital

Harvard Medical School

Migraine Headaches Associated with the Menstrual Cycle

Up to 25% of women experience migraine headaches during their reproductive years; often migraine headaches may be triggered or exacerbated by hormonal changes. It has been estimated that 7-14% of women experience migraines only during the premenstrual or menstrual phase of their cycles. Another 52-70% experience headaches throughout the month but note increased headache activity before or during menses.

Interestingly, before puberty, the prevalence of migraine appears to be similar for boys and girls. Peak migraine incidence in girls occurs at menarche, and in adulthood females outnumber male migraine sufferers by about 3 to 1.

The reported effects of pregnancy, oral contraceptives and menopause on migraine headache patterns have been variable. It is believed that declining estrogen levels may be an important trigger, and it is thought that progesterone may also play a role. Migraine often, but not always, improves during pregnancy; however, postpartum migraine flares are common. The effects of oral contraceptive use are quite variable: migraines may improve, worsen, or remain the same. Low estrogen dose oral contraceptives usually have no effect or may improve migraine. Estrogen replacement therapy for menopausal women often exacerbates migraines.

Treatment options include aspirin, ibuprofen, or acetaminophen, often combined with caffeine, for mild attacks. Triptans (including sumatriptan) or DHE (dihydroergotamine) may be used for moderate to severe attacks. Migraine prophylactic agents include beta-blockers, calcium channel blockers, tricyclic antidepressants, anti-epileptic agents, and serotonin receptor antagonists. For menstrual migraines, estradiol-containing compounds medications (oral, transdermal or percutaneous gel) may be used to prevent migraines. Progesterone alone appears to have little therapeutic value. In general, it is helpful for a woman experiencing new onset or exacerbation of migraine to seek consultation from a neurologist.

Kimberly H. Pearson, MD

Women’s Mental Health. Kornstein SG, Clayton AH. The Guilford Press: New York. 2002.

Brandes JL. The influence of estrogen on migraine: a systematic review. JAMA. 2006 Apr 19;295(15):1824-30. Loder EW. Menstrual migraine: pathophysiology, diagnosis, and impact. Headache. 2006 Oct;46 Suppl 2:S55-60.

Share This Page:
Email this to someoneShare on Facebook0Tweet about this on TwitterShare on Google+0Share on LinkedIn0Share on Reddit0Buffer this pagePrint this page

, , , , , , , , ,

17 Responses to Migraine Headaches Associated with the Menstrual Cycle

  1. Concerned April 10, 2008 at 11:32 am #

    Has anyone else with migraines had a hard time getting their doctor to prescribe the birth control pill? My gynecologist was very concerned about putting me on the pill, but the neurologist said it was fine. Since going back on the pill my headaches have actually gotten better.

  2. Jacqueline July 30, 2008 at 9:00 pm #

    For the past two and a half years, I have been dealing with Migraines on literally a daily basis. Is there any one else who has had this problem? And are there any solutions? Any help would be appreciated. Thank you.

    ~jaquie

  3. kelly October 19, 2008 at 1:53 am #

    For years, I’ve had terrible migraines lasting for days. I notice a connection with my hormones even though I have irregular cycles due to PCOS. My gyno said it was impossible to have headaches throughout the month because of hormones, because the only change is right before your period. Anyone else have this problem?

  4. Antonina December 17, 2008 at 7:38 am #

    Since l was 11 l have had very severe migraines,vomiting paralase,severe pain in my head,and other symptoms.At 14, l started my period,they used to be irregular and very painful,l,d faint, so bad l couldn,t attend school.l,m 40 now and after 3 children,there more regular,but l,m suffering PMDD,l still have severe migraines which didn,t stop ,or get better when l was pregnant,and l feel my symptoms start when my body is trying to ovulate.l often have terrible pain through ovulation.l feel its got worse recently and its affecting my relationship with my husband who ,still can,t understand whats wrong with me,and is unable to give me support.l,ve tryed to help myself but sometimes l feel so low.r

  5. Kodi February 25, 2009 at 4:58 am #

    I recently(past 2 months) have had migrains on a daily basis, practically 24/7. And I finally got fed up with it and went to the doctor, I almost had myself convinced I had a brain tumor. but my doctor gave me no explanation to why I have my migrains. And my period lasts me a month to two months long, so this kind of makes sense how the two link together. But I was prescribed with a high blood pressure medicine to control my migrains and so far thy seem to be working.

  6. elisa April 21, 2009 at 9:44 am #

    I have been sufering from hormonal migranes since 11 years old it has been awful. To this day im still suffering, from migranes and usually it happens 2 weeks after my menstrual. Birth control has help alot!

  7. Gina B. October 5, 2009 at 9:09 pm #

    I get migranes all the time, but have never had the sensation that they are connected with my menstrual cycle! Very informative article here.

    Menstrual Cramp Remedies

  8. amy November 16, 2009 at 10:57 pm #

    @Concerned, Yes, it’s because the pill usually increases your chances of getting a stroke. And if you suffer or used to suffer from regular miagraines then your chances are even higher of getting a stroke.

  9. Marie March 18, 2010 at 4:26 pm #

    I have suffered for years with Menstrual migraines. 5 years ago, I found my cure! For me, removing the salt from my diet from about 2 days before my period through the end of my period and drinking water to “flush” out my system. It works 100%! No salt means no dining out, no packaged foods…I cook fresh food at home so I know whats in it. If I get weak and eat what I crave like sushi or chips, I get a migraine, so I start flushing with water. No pills, no pain, no monthly anxiety. My life has improved!

  10. Sara May 19, 2010 at 4:45 pm #

    I went off the Pill two years ago after 18 years of continual use in order to try and conceive, and my semi-regular migraines seem to have completely disappeared since then. I went to different doctors, tried various OTC and prescription meds over the years, but never made the connection to the hormones in birth control. Still haven’t had a successful pregnancy (2 miscarriages), but I believe it’s more age-related (I’m now 37) than due to medication. Wondering if anyone has had a similar experience…

  11. Aruna June 15, 2010 at 11:10 am #

    I could associate my eating habits with my migraines…I have been dealing with them for over years now. I have noticed acidic foods to trigger my migraine.

    Appreciate your share, I will try your easy-to-follow remedy, will be ever grateful if it should work for me too.

  12. gypsy June 28, 2010 at 1:59 pm #

    I have been suffering with chronic migraines for over 8 yrs now. I do take immitrex for them but have noticed in the last couple years they are way more prominent around my period. I get them before,during and after… My life is not good for about 1 1/2 to 2 weeks. I”m trying to get pregnant and have had no success yet but doctors say they cant help me since I am trying to get pregnant.. according to them my hormone levels are fine… i dont know.. i beg to differ.. anyone else with this problem?

  13. Jake Lopez July 5, 2010 at 12:02 pm #

    My wife suffers form migraines all the time and her doctor told her a long list of things to avoid. Red wine was one of them, something about the sulphates in it?? Really any alcohol will trigger them, but red wine especially.

  14. Joanne October 22, 2012 at 5:40 am #

    This article has been brilliant for me to find i am 34 and have wondered whats the matter with me as i suffer with all the symptoms given and thought i was faling to bits every month, i can now tackle my problem head on and hope for a better future and make everyones life easier living with me!! i am a very active person i excersise and eat well but pms affects me so badly everything can grind to a holt before my period starts its horrible.. i go from being able to cope and do everything to just struggling through!! i now know to seek help and target the problem!!

  15. Sonya January 13, 2013 at 2:03 am #

    I am surprised that the article doesn’t mention Magnesium supplements for migraines.

    Studies have shown that people who suffer from migraines have lower magnesium levels than people who don’t. Research has shown that magnesium supplementation can prevent and treat migraines in a greater percentage of people than placebo.

    http://www.ncbi.nlm.nih.gov/pubmed/9523054

  16. carolyn December 22, 2013 at 7:53 pm #

    I have a niece who had a constant migraine, debilitating for 3 mths. Doctors, all kinds of tests, and no relief. I convinced her to keep food journal, Avoid Gluten, and of course some of the other mentioned above, Big difference. Was able to go back to school, (now in college) still gluten free and now some menstrual migraines appearing 🙁 Little stress? Hormones? Not enough exercise? Avoiding and staying gluten free though, saw major changes within days.

  17. Sarah August 30, 2015 at 1:53 am #

    I know this is an old post, but for anyone else who is reading it… I’ve had migraines during and right before my period since I was 12, and the best thing is Benadryl (diphenhydramine) I don’t know why it works, but I also read somewhere that people who are hospitalized for migraines are sometimes put on a slow iv drip of benadryl. As soon as I feel a migraine starting to happen, I pop 1 or 2 ibuprofen and drink like 3 glasses of water. If it’s still getting worse 20 mins later, or I start to feel nauseous, I take 1/2 a benadryl. (Benadryl makes me super sleepy so I wait to make sure I need it and try to take the lowest dose! But if it’s the weekend and you’ve nothing better to do then by all means pop a whole one and take a nap. 🙂 ) It’s all about catching it early too.

    If you’ve waited too long and you’re in agony, Take 4 ibuprofen** and a whole benadryl, or 2 benadryl if it’s something you take frequently and have a tolerance for.

    It helps if you can lay down in a dark, quiet space for a good half hour while your meds kick in, and if you’ve waited too long and it’s pounding you’ll probable need at least an hour, sometimes even a long nap. You can repeat the Benadryl and Advil later if you need to, just make sure you wait a good 6 hours in between if you took a larger dose of Advil.

    ** (unless you never take advil, or are sensitive to NSAIDs, then 2 or 3 is probably fine for you, but 4 Advil = 800 mg of ibuprofen which is the normal dose most doctors prescribe for any sort of injury that warrants an ibuprofen prescription, so it’s not as bad as it sounds. And if you have a sensitive tummy eat something with the advil! And don’t take that many if you have a recent history of stomach ulcers without talking to your doctor. And don’t take that many if you’ve already taken aspirin. By the way: Aspirin(Bayer) + Ibuprofen(Advil) = good risk of stomach bleeding so do not mix! Aspirin(Bayer) + acetaminophen/paracetamol(Tylenol) and ibuprofen(Advil) + acetaminophen/paracetamol(Tylenol) = all okay unless you have like liver problems or something, then I think you’re supposed to ask your doctor. Just because I know a lot of people that mix up all those drugs and don’t know about interactions, and when you have a migraine you sometimes just grab whatever you can get your hands on!

    And I don’t get them every period, but most of them, and I have noticed that I’ve usually had something really salty an hour or 2 before.

Leave a Reply