Migraine during your period: what to do?

Quick overview: Frequently asked questions and answers

What is menstrual migraine? This is a migraine that occurs close to menstruation. The causes are hormonal fluctuations such as a drop in estrogen levels.

Can hormonal contraception affect menstrual migraines? Yes. Hormonal contraceptives such as the pill often make symptoms worse. Depending on the type of migraine, progestin preparations may be helpful. In some women, hormone treatment can also improve migraines.

Does menstrual migraine always occur during your period? The symptoms can occur as early as two days before the start of the period. Menstrual migraines can also occur up to three days after the start of bleeding.

Article contents at a glance:

What is menstrual migraine?

Migraine attacks are often triggered by hormonal fluctuations. Women are affected around three times more often than men, as hormone levels constantly change during the cycle. They often suffer from migraine-related headaches, especially around their period.

Two forms are distinguished here:

• Menstrual migraine: The migraine starts two days before to three days after the start of the period.

• Menstrual-associated migraine: Migraine attacks can also occur on other days during the cycle.

The influence of female sex hormones on the development of migraines is also evident in the fact that girls and boys suffer from migraines equally often. It is only when menstruation begins during puberty that the proportion of women with migraines increases significantly.

Hormonal migraines also usually decrease during pregnancy and after menopause, as there are fewer or no more hormonal fluctuations.

Migraine during your period: causes

Around seven percent of women with migraines suffer from menstrual migraines, but the proportion of patients with menstruation-associated migraines is much higher.

Shortly before menstruation, the concentration of the female sex hormone estrogen drops sharply. This drop in hormones before menstruation makes women sensitive to stress factors that can trigger a migraine attack.

There is evidence that female sex hormones also influence pain processing in the brain. The amount of estrogen probably affects the serotonin level. It increases the amount of the “happiness hormone” in the brain. If the estrogen level falls, the amount of serotonin also decreases. This means that pain stimuli are processed less effectively in the brain.

Studies also suggest that women with menstrual migraines have an increased release of CGRP (calcitonin gene-related peptide). This inflammatory messenger substance dilates the blood vessels in the brain and causes inflammatory reactions that lead to severe headaches.

Symptoms of menstrual migraine

Menstrual migraine typically occurs up to two days before the onset of the period and up to three days after the onset of menstruation It is best diagnosed using a migraine diary.

In most cases, the symptoms of migraines occur without an aura – that is, without neurological deficits such as numbness in the face, vision or speech disorders. The pain of menstrual migraines is often more severe than that of normal migraines.

In addition to headaches, the following symptoms may occur during menstrual migraines:

Another characteristic feature is a longer duration: occasionally the migraine attack – with small interruptions – even lasts for a week.

Treatment of hormonal migraines

Basically, the treatment of a migraine during your period is no different from that of a “normal” migraine. Since the attacks of menstrual migraine often last for days, medication is recommended for acute treatment of migraines using painkillers with a long-lasting effect, such as naproxen.

However, these medicines should not be taken for longer than seven days at a time, otherwise headaches could occur again.

Metoclopramide or domperidone are also effective against nausea and vomiting. For moderate to severe attacks, the German Migraine and Headache Society recommends prescription migraine medications from the triptan group.

It is also beneficial to avoid stress in the days before your period and to give your body some rest.

Pill for menstrual migraines

In some circumstances, it may also be useful to specifically achieve a constant hormone level by administering suitable hormones.

The following are possible on a hormonal basis:

• Taking a combined contraceptive pill in a long cycle, i.e. three months without a pill break

• Taking an estrogen-free pill, which is also taken in a long cycle without a pill break

• Hormone preparations with a consistent release of active ingredients, such as hormone patches, which the patient applies prophylactically before the onset of symptoms (two days before the period) and wears during the period. This is only suitable for very regular cycles.

Notice: The contraceptive pill and hormones are not generally suitable for all migraine patients. Some report a worsening of symptoms, while others benefit. This depends on individual tolerance.

In addition, according to the World Health Organization (WHO), patients with migraine with aura should not take hormonal contraceptives.

In general, migraine patients who smoke and are over 40 are advised not to take the pill due to the increased risk of stroke. It is important to consult a doctor to determine which hormonal treatment options are suitable in each individual case.

Prognosis and course of menstrual migraine

Since menstrual migraines are estrogen-dependent, there is a good prognosis that they will disappear during menopause. In about 60 percent of women, migraines improve after menopause.