Q&A: migraine and women’s health

By: Steph Weatherley, Information and Support Services Advisor, and Ria Bhola, Headache Nurse Specialist, The Migraine Trust

11th March 2022

In this blog, we answer common questions we get asked about migraine and women’s health via The Migraine Trust helpline.

My migraine attacks are linked to my menstrual cycle, why is this?

Migraine and hormones are closely linked and some people are very sensitive to hormonal changes and find their migraine is triggered by the drop in oestrogen that occurs just before a period.

Some people have migraine attacks just at ovulation and menstruation, which is referred to as pure menstrual migraine. Many people will have a mix of hormone and non-hormone-related migraine attacks during the month.

How can I treat menstrual migraine?

There are different options available and your doctor should suggest the option that suits you. This will depend on your symptoms and any other medical conditions. Treatment could include non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, or triptans. You can learn more acute medicines here.

If you have irregular periods or need contraception, there are a range of contraceptives that may help with your menstrual migraine. Your doctor should be able to suggest an appropriate option for you.

Some women may speak to their GP about topping up their oestrogen levels before and during their period which may help with menstrual migraine. Oestrogen can be taken as skin patches or gel. This is most likely to be effective when your periods are regular and you can top up the oestrogen for seven days, starting three days before your period. You should not use oestrogen supplements if you think you are pregnant or you are trying to get pregnant.

I am going through the menopause, what can I do to help my migraine?

The menopause and perimenopause phase is a period of a few years when menstrual cycles become irregular. For people who experience migraine attacks linked to their hormone fluctuations, this can be a very unsettled time. To manage your migraine during this time, it may be useful to consider a preventive treatment, in discussion with your doctor. They may wish to refer you to a menopause clinic to consider options that might help to stabilise your hormone levels, which in turn could improve your migraine attacks.

I have migraine but want to get pregnant, do I need to stop my preventive treatment?

During pregnancy and breastfeeding, it is better to avoid using medicines where possible and there are several non-drug treatments available.

However, poorly controlled headache can lead to stress, sleep deprivation, depression and poor nutritional intake which in turn can have harmful effects for mother and baby. Therefore, if non-drug treatments are not effective, a treatment choice can be made, considering all the benefits and possible risks, in discussion with your doctor.

These can be simple painkillers like ibuprofen and paracetamol which can be taken as normal during breastfeeding although aspirin should be avoided as a painkiller.

Sumatriptan use in breastfeeding is considered safe as very small amounts of the drug are available in the breastmilk. Less evidence has been collected on the other triptans and as such breastmilk may be best discarded if breastfeeding 24 hours after use of these triptans as extra safety precaution.

If you are taking any preventive treatments for your migraine, you should urgently discuss stopping or reducing these with your doctor.

Will a hysterectomy help my migraine?

Generally, the current research doesn’t support hysterectomy as a means to treat migraine, as it doesn’t usually improve the migraine and can make it worse. If you do have a hysterectomy, additional oestrogen can help to reduce the symptoms. If migraine does worsen after having a hysterectomy, this generally settles in a couple of years.

Women’s Health Concern have some more information about hysterectomy and migraine which may be of interest. You can find out more on their website here.

Will my daughter’s migraine stop when she reaches puberty?

In children migraine tends to affect boys and girls equally, however, after puberty a lot of boys find their migraine attacks stop whereas in girls, migraine is more prevalent after puberty.

There are many treatments available for children with migraine, and the most suitable one will depend on their medical history, age and symptoms. You can discuss suitable medications with your GP.

If you have further questions about your migraine or are in need of support, you can speak to us via our free helpline on 0808 802 0066 or via our online contact form.

Read more about menstrual migraine here. Read more about the relationship between migraine and hormones, including HRT, contraception and the menopause, here.