What is menstrual migraine?

Migraine affects more women than men, and there is a known link between migraine and hormonal changes throughout a woman’s life. More than half of women with migraine report menstruation (having a period) as a trigger for their migraine attacks.

Symptoms

Menstrual migraine refers to migraine attacks that are linked to menstruation, and that occur with your period.

They tend to be more severe and less responsive to treatment. They can also last longer than other types of migraine.

Most women also experience migraine at other times of the month. It’s thought that fewer than one in ten women have ‘pure menstrual migraine’. This is where you only have migraine during menstruation and not at any other times.

What causes menstrual migraine?

There is a link between migraine and falling levels of the hormone oestrogen. The natural drop in oestrogen levels before your period starts is linked to menstrual migraine. Women who have heavy and painful periods have higher levels of prostaglandin (another hormone), which has also been identified as playing a role in a menstrual migraine.

How is menstrual migraine diagnosed?

There are no tests available for menstrual migraine. The most accurate way to tell if you have menstrual migraine is to keep a diary for at least three months recording both your migraine attacks and the days you menstruate.

For menstrual migraine to be diagnosed migraine should occur predominately between two days before and up to three days into menstruation, in at least two out of three consecutive menstrual cycles.

Treatment options for menstrual migraine

There are several treatment options depending on the regularity of your menstrual cycle, whether or not you have painful or heavy periods, menopausal symptoms  or if you also need contraception.

If you have regular periods your doctor may suggest taking medication for a few days around the time of menstruation (generally two days before and up to three days after bleeding starts).

There are different options available and your doctor should suggest the option that suits you. It could include non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or mefenamic acid, oestrogen supplements or triptans.

• Frovatriptan tablet (2.5 mg twice daily on the days migraine is expected  – generally from two days before until three days after bleeding starts)
• Zolmitriptan tablet (2.5 mg twice or three times a day on the days migraine is expected  – generally from two days before until three days after bleeding starts)

(Taken from the British Association for the Study of Headache’s National Headache Management System for Adults 2019)

It is possible that these treatments may delay the migraine attack rather than prevent it.

Contraception

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.

If you take the combined pill and have migraine during the pill free week you can take the pill without a break to help manage the menstrual migraine.

In migraine with aura progestogen (another hormone) only options are recommended, and can be effective for some women with menstrual migraine. However, some women do experience irregular bleeding and this can be accompanied by migraine.

Hormone supplements

Some women find topping up their oestrogen levels before and during their period can 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 3 days before your period. You should not use oestrogen supplements if you think you are pregnant or you are trying to get pregnant.

For more information about using oestrogen supplements speak to your doctor.