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Understanding Menstrual Migraine

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Updated April 03, 2012

For women during that “time-of-the-month,” the stomach cramps, food cravings, irritability, and fatigue associated with a monthly period can be a major lifestyle setback. Add a migraine to this mix, and you have a recipe for a day in bed. The good news is we have a better understanding of what causes menstrual migraines and what you might be able to do to treat them. If you or someone you know suffers from menstrual migraines, find out more about them and what you can do to gain some control over them.

What Causes Menstrual Migraines?
Migraines are severe headaches caused by the enlargement of blood vessels in the head. The nerve fibers around these blood vessels react to the enlargement, causing an intense throbbing pain. Some migraine sufferers experience an aura, which warns the individual that a migraine is arriving. More common symptoms can be seeing flashing lights, blind spots, sensitivity to light and sound, nausea, and tingling in the extremities. About 75% of migraine sufferers are female, and of this group, 60-70% experience migraines triggered by the menstrual cycle. Researchers have found a strong connection between estrogen hormones and migraine headaches, which is why women tend to be more impacted by migraines than men. Typically, higher estrogen levels will prevent migraine headaches, whereas lower estrogen levels will result in a migraine headache. Because a woman’s estrogen levels are lowest when she is menstruating, its usually the time that migraine headaches are most likely to occur. It is also important to note that fluctuating estrogen levels can also cause migraines. In addition, every woman reacts differently to hormones, so a woman may have hormone-related migraines even when she does not have her period.

Can the Hormonal Changes In My Body That Cause Menstrual Migraines Cause Migraines at Other Times, Too?
In addition to the menstrual cycle, there are other periods in a woman’s lifetime when her hormone levels change drastically, and can impact hormone-related migraines. Many women find that their migraines are greatly reduced or even disappear during pregnancy due to strady state-levels of estrogen. It’s thought that this may “protect” the brain against migraines. A dip in estrogen levels after the birth of the baby can trigger migraines once again.

Perimenopause and menopause also impact hormone levels, and thus, migraines. During this time, the body’s hormones levels tend to rise and drop dramatically; this fluctuation can trigger migraine headaches. Many women comment that their migraines disappear when they enter menopause and no longer get their period. However, there also tends to be an increase in tension headaches for women in this period of their life. It is also important to take into consideration that fact that some women use hormone therapy to treat symptoms of menopause; this can result in an increase or decrease of migraine headaches, depending on how the woman’s body responds to the hormones taken.

Can Menstrual Migraines Be Prevented?
Because menstrual migraines are caused by lower hormone levels, taking birth control pills that maintain the body’s hormone levels may help reduce a woman’s menstrual migraines. Birth control pills that give a woman a menstrual period seasonally may reduce menstrual migraines by eliminating the woman’s period and thus the associated migraines. It is important to keep in mind that every woman’s body responds to hormones differently, so you may need to try a few different birth control methods to find one that works to eliminate your menstrual migraines. Some physicians advise that using birth control with fewer placebo days, using estrogen birth control patches during your placebo week, or using progestin only birth control work best to prevent menstrual migraines.

Women who have predictable, regular periods are able to use another method to prevent their menstrual migraines. This includes taking preventative migraine medicine a few days before your period, as well for the first few days during your period. Learning to recognize other migraine triggers, such as stress, lack of sleep, or irregular eating, can also help to prevent menstrual migraines.

How Is the Pain From Menstrual Migraines Treated?
Menstrual migraines are treated in the same way as typical migraines. This includes using a pain reliever, such as acetaminophen or ibuprofen. Your doctor can prescribe you a migraine medicine if over the counter pain relievers are not effective. Other care methods that may work to relieve the pain include massage, application of ice, and resting in a dark, quiet room. Consult with a neurologist for treatment methods that might work best for you.

Sources:

MacGregor EA. Prevention and treatment of menstrual migraine. Drugs. 2010 Oct 1;70(14):1799-818.

Russell MB. Genetics of menstrual migraine: the epidemiological evidence. Curr Pain Headache Rep. 2010 Oct;14(5):385-8.

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