Chapter 1, Episode 7: What is Menstrual Migraine?


This content has been medically reviewed by Dr. Mary A. O’Neal.

Menstrual migraine refers to migraine attacks that start right before or during a woman’s period, or menstruation, and occur in more than 60 percent of their cycles. It is attributed to falling estrogen levels that occur with menstruation. 

Estrogen is responsible for synthesis and secretion of chemicals that help stabilize our bodies such as serotonin, dopamine, and endorphins. When estrogen levels fall, levels of chemicals also fall and cause pain sensitivity to increase throughout the nervous system. 

The symptoms of a menstrual migraine attack may include intense head pain, nausea, sensitivity to light and/or sound and more. 

There are two subtypes of menstrual migraine: Menstrually-related migraine and pure menstrual migraine. Pure Menstrual Migraine occurs only one or two days before or after the onset of your period while menstrually-related migraine occurs one to two days before or after the onset of your period AND at other times in your cycle. 

Pure menstrual migraine and menstrually related migraine attacks are often more intense than non-menstrual headaches, typically resistant to treatment, and last longer. Menstrually related migraine is more common than pure menstrual migraine.

If you aren’t sure if you are experiencing menstrual migraine, using a diary to track your menstrual cycle and which days your attacks occur may be helpful.

For mild to moderate symptoms, patients can utilize over-the-counter medications such as ibuprofen, naproxen or an acetaminophen-aspirin combination with or without caffeine. For moderate to severe symptoms, a prescribed oral triptan may be recommended. Due to the high prevalence of nausea during menstrual migraine, anti-nausea medication such as metoclopramide can be helpful. For symptoms that aren’t responding to those treatments, a subcutaneous triptan, intramuscular ketorolac, or DHE nasal spray may be helpful options.

400 mg of magnesium taken daily for a week starting on the 15th day of the cycle may be effective for preventing menstrual migraine. Another preventive option is a method called mini-prophylaxis. This uses preventive medications a week before anticipated menstruation and may include supplements, analgesics or triptans. Talk with your healthcare provider before starting mini-prophylaxis.  

Because of its affect on hormones, birth control can affect menstrual migraine. Combined oral contraceptives have 21 pills with supplementary estrogen and progestin and then 7 placebo pills. During the placebo week, migraine may be worse due to the drop in estrogen. Continuous oral contraception, which does not have a placebo week, may help prevent attacks by maintaining more consistent levels of estrogen. It has been found to reduce the number of migraine days, the amount of analgesics used and the intensity of symptoms. These options should not be used in people with migraine with aura. 

While birth control can help some people, it can also cause an onset of migraine or result in more severe attacks for others.

A  multidisciplinary approach between a gynecologist and a neurologist may be most effective for diagnosing and treating menstrual migraine.

This video is sponsored in part by Amgen, Abbvie, Biohaven Pharmaceuticals, Impel Pharmaceuticals and Collegium Pharmaceutical.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.