Overview of Menstrual Migraine Headaches

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Do you have migraine headaches that occur just before or just after your period starts? Do your headaches also occur at other times during your menstrual cycle? If so, you likely have what is known as a menstrual migraine.

Menstrual Migraine

About 18 % of women in the US report suffering from migraines. Most of these women will report their first migraine before the age of 35. About half of these women say that there is an association between their migraines and their menstruation.

If you suffer from headaches that have some relationship to your period you have what is referred to as a menstrual migraine. These cycle related headaches can be further classified into:

Pure Menstrual Migraine

A pure menstrual migraine is a migraine headache that occurs ONLY on 1-2 days before or after the onset of your period. Pure menstrual migraines are without aura. To make the diagnosis of a pure menstrual migraine you can not suffer from migraines at any other time during your menstrual cycle. Also, the headache must occur in more than 60% of your cycles. Pure menstrual migraines occur in only about 10% of women with menstrual migraines making them much less common than the other menstrual migraine type, menstrually related migraines.

Menstrually-related migraine

If you suffer from migraines at other times of your cycle in addition to right around your period you have what is known as a menstrually related migraine. Menstrually related migraines are a migraine headache that occurs on 1-2 days before or after the onset of your period. These migraines are without aura even if your migraines at other times in your cycle are associated with an aura. Again, these migraines have to occur in more than 60% of your cycles. 

Track Your Cycle Chart Your Headache

Before discussing your headache with your doctor it is a good idea to chart your headaches in relation to your period. If you don’t already have a menstrual cycle calendar, now is a good time to start one. Keeping track of when you have headaches can help your doctor determine what type of a headache you may have, including whether you have menstrually related migraines.

Menstrual migraines can occur in isolation or can be one of the complaints of Premenstrual Syndrome (PMS).  The other symptoms of PMS include:

  • Nausea
  • Bloating
  • Swelling
  • Breast tenderness
  • Mood swings
  • Backache

Menstrual migraines can also be associated with painful periods.

Treatment Options

The treatment of an acute migraine attack is the same for menstrual migraines as it is for non-menstrual migraines. The first strategy in managing a menstrual migraine is to rest in a cool and dark room. Some women will have great success with a strong cup of coffee or caffeine although how this works is somewhat unclear. 

First-line medications are the pain relievers and anti- inflammatory agents such as:

  • Aspirin
  • Acetaminophen
  • Ibuprofen and other NSAIDs

Some women will require stronger migraine-specific medications including:

  • Fioricet (an analgesic, sedative, caffeine combination)
  • ergot derivatives
  • triptans

In addition to medication and basic lifestyle modifications, there are other complementary and alternative medical options for migraine management.

Managing Menstrual Migraines With Cycle Control

Perhaps the most important reason to determine if you suffer from one on the menstrual migraine variants is that there are strategies to help eliminate or at least reduce the occurrence of these types of migraines.

It is thought that the cyclic changes in your hormone levels are a significant trigger for menstrual migraines. Medications that reduce these hormone fluctuations have been shown to improve menstrual migraines especially pure menstrual migraines. 

The most common of these strategies is the continuous use of the oral contraceptive pill. Not only does this inhibit ovulation, which is the trigger for the hormone changes it also maintains estrogen levels by eliminating the hormone free week associated with the cyclic use of the birth control pill. However, If you have menstrually related migraines it is possible that the estrogen-containing oral contraceptive pill could increase your migraine attacks at other times in your cycle or perhaps induce an aura. If you develop a worsening of your migraines or an aura while you are on the birth control pill it is important that you let your healthcare provider know about this.

If the oral contraceptive pill does not improve your migraine your doctor may discuss with you other hormone medications such as estrogen supplementation during the luteal phase of your cycle or high dose progestins or GnRH agonists to prevent ovulation. Your doctor may also discuss using a combination of hormones and analgesics or migraine-specific medications to interrupt the cyclic occurrence of your migraine.

A Word From Tips For Healthy Living

Migraine headaches can be very debilitating. Keeping track of when your headaches occur during your menstrual cycle can help you better manage your symptoms.

As always, be sure to discuss any headaches or related symptoms that occur during your menstrual cycle with your healthcare provider.

Updated by Andrea Chisholm, MD.

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