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How Can I Prevent Menstrual Migraines?

Migraines that occur right around the same time as a menstrual period are called menstrual migraines or
Migraines that occur right around the same time as a menstrual period are called menstrual migraines or "hormone headaches." Some women can prevent menstrual migraines by taking certain medications 5-7 days before their menstrual period starts, including nonsteroidal anti-inflammatories (NSAIDs), estrogen supplementation, triptans, and magnesium.

A migraine headache is a neurological condition in which patients experience severe head pain along with sensitivity to light, sound, or smells.

About 2/3 of women who suffer migraines have them around the same time as their period. Migraine attacks that start between two days before a woman’s menstrual period and the third day of flow are usually considered menstrual migraines. 

Menstrual migraine attacks, also called “hormone headaches,” tend to be more severe, last longer, and cause greater light sensitivity than attacks that happen during other times of the month.

Some women may be able to prevent menstrual migraines with a mini-preventive treatment by taking medications for 5 to 7 days in a row prior to the onset of the menstrual migraine attacks. 

Medications used to prevent menstrual migraines may include those mentioned in the table below.

Treatments for Menstrual Migraine
Migraine Medication Type Uses

Nonsteroidal anti-inflammatories (NSAIDs) 
  • Taken twice daily in the 5 to 7 days around the start of a woman’s period
Hormones
  • Estrogen supplementation with a pill, vaginal gel, or patch during the menstrual week 
Triptans
  • Long-lasting triptans such as naratriptan and frovatriptan are usually recommended
  • Dosed twice daily through a woman’s period
Magnesium supplementation
  • Started on day 15 of the menstrual cycle, or 15 days from the start of a woman’s period, and continued until the next period begins

Other Treatment Options

Mini-prevention does not work for every woman to prevent menstrual migraines. For these women, treatment used throughout the month may be more effective. Continuous treatment to prevent menstrual migraines may include hormones. 

  • Dosing birth control pills continuously so there is no break for a monthly period 
  • The vaginal ring can be used so when a woman removes the ring, a new one is inserted immediately instead of waiting for the end of the menstrual period

What Are Symptoms of Menstrual Migraines?

Symptoms of menstrual migraine tend to be more severe, last longer, and cause greater light sensitivity than attacks at other times of the month. Menstrual migraine symptoms are similar to migraine without aura.

  • Prodrome: warnings before a migraine
    • Changed in mood
    • Slight changes in sensations such as an abnormal taste or smell
    • Fatigue
    • Muscle tension 
  • Headache: may last 4 to 72 hours
    • Usually occurs on one side of the head, though can occur on both sides
    • Throbbing pain 
    • Nausea
    • Vomiting
    • Sensitivity to light (photophobia) and sound (phonophobia)
  • Postdrome: some signs may remain after the pain subsides
    • Inability to eat
    • Problems with concentration
    • Fatigue

 

What Causes a Menstrual Migraine?

The rapid drop in estrogen levels just before a woman’s menstrual period causes menstrual migraines.

How Is a Menstrual Migraine Diagnosed?

Doctors diagnose migraine headaches based on a patient’s medical history and the description of symptoms. A physical examination may be done but usually it will not find anything out of the ordinary. A neurological examination is often performed to help rule out other causes of the symptoms.

Additional tests may also be used to help rule out other causes for the symptoms such as: 

How Do I Get Rid of or Prevent Menstrual Migraines?

Menstrual migraines do not always respond to the same medications used to treat migraine attacks that occur at other times of the month. The reason is unclear, but it is thought to be due to the effects of estrogen on the medications. 

Treatment for menstrual migraine attacks may include: 

  • Fast-acting oral triptans (such as sumatriptan, rizatriptan, zolmitriptan, almotriptan, or eletriptan) taken early in a migraine attack in combination with a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • Injectable medications that can be taken in the middle of a migraine attack for faster relief, may also be combined with an NSAID
    • Sumatriptan, the only injectable triptan
    • Dihydroergotamine (DHE)
  • Nasal triptans such as zolmitriptan or sumatriptan work faster than pills but not as quickly as an injection
    • DHE is also available as a nasal spray

Non-medical treatment for menstrual migraines may also include: 

  • Home remedies
    • Ice 
    • Heat
    • A dark room/covering your eyes
    • Hydration
    • Deep breathing
    • Rest
    • Massage
    • Biofeedback
  • Avoiding known triggers, such as
    • Stress
    • Bright lights
    • Certain smells
    • Withdrawal from caffeine
    • Hunger/skipping meals
    • Certain foods and drinks, such as chocolate, processed foods with monosodium glutamate (MSG), and alcohol
    • Anxiety
    • Anger
    • Poor sleep
    • Fatigue
    • Exposure to smoke

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Migraines and Headaches Resources
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References
https://americanmigrainefoundation.org/resource-library/what-is-migraine/

https://americanmigrainefoundation.org/resource-library/menstrual-migraine-treatment-and-prevention/

https://www.uptodate.com/contents/migraines-in-adults-beyond-the-basics?search=migraine&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?search=headache%20treatment&source=search_result&selectedTitle=7~150&usage_type=default&display_rank=7

https://www.migraineagain.com/how-to-get-rid-of-a-migraine-fast/