About menstrual migraine

In menstrual migraine, you have migraine attacks linked to your periods (menstrual cycle). These migraine attacks tend to happen from around two days before your period starts, up to the third day of your period. However, this can vary for everyone.

Menstrual migraine is very common. It can start from when you start your periods and carry on until they stop in menopause. In a recent study, it was shown that as many as two-thirds of women with migraine may have migraine attacks related to their periods.

If you have menstrual migraine, you will usually have migraine attacks at other times of the month too. This is known as menstrually-related migraine. But if you only have them around the time of your periods, it’s known as ‘pure’ menstrual migraine. Fewer than 1 in 100 women with migraine are thought to have pure menstrual migraine.

How menstrual migraine is different from non-menstrual migraine

Menstrual migraine attacks tend to be longer and more severe compared with migraine attacks at other times. As well as head pain, you may be more likely to feel or be sick, and to have sensitivity to light or sounds.

Menstrual migraine attacks are more likely to be without aura, even if you get migraine with aura at other times of the month.

Migraine attacks linked to periods may also be more difficult to treat.

Why you get migraine attacks during your period

Migraine and hormones are closely linked. A drop in levels of the hormone oestrogen is a common trigger for migraine. Your oestrogen levels naturally fall in the days leading up to your period. This makes a migraine attack more likely during your period.

Hormone-like substances called prostaglandins have also been linked to migraine. Your body releases more prostaglandins around the time of your period. These can lead to period pain, as well as increase the risk of a migraine.

Migraine attacks can get worse as you approach menopause, as oestrogen levels fluctuate. They may improve after menopause, when your periods have stopped and your oestrogen level stabilise. But this isn’t the case for everyone and it can be years after menopause.

How to tell if you have menstrual migraine

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. Use the diary to record both your migraine attacks and the days you are on your period. This can help you to track your cycle and see if there is a link with your migraine.

Menstrual migraine means you have migraine attacks that occur from two days before your period, up to the third day of your period. These affect at least two out of three periods. Your doctor can confirm whether you have menstrual migraine. They will base this on your symptoms and the timings reported in your diary.

Treatment options for menstrual migraine

Standard medicines for migraine can be used to treat menstrual migraine. These include:

• acute medicines to treat a migraine attack
• preventive medicines to reduce migraine frequency and severity.

You may also choose to try non-drug treatment options, such as supplements and migraine devices.

Your doctor may also suggest some other treatment options for menstrual migraine. These will depend on several things individual to you. They may include how regular your periods are, whether or not you have painful or heavy periods, and whether you also need contraception.

Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)

You can use standard painkillers to help with menstrual migraine. These include paracetamol and ibuprofen. If you get painful periods too, you may find stronger non-steroidal anti-inflammatory drugs (NSAIDs) help. These include naproxen and mefenamic acid. Ask your pharmacist for more information. You will need a prescription from a doctor for mefenamic acid.

Triptans

Sometimes your doctor may suggest taking triptans for a few days around the time of your periods. A type of triptan called frovatriptan is commonly used for this.  You take the medication on the days that you usually expect migraine attacks. If your periods are regular and predictable, this might be around two days before and up to three days after your period starts. If you have irregular periods, it might still help to take triptans when your period starts for three days.

Taking painkillers or triptans too often and for too long can lead to medication overuse headache. This is a complication that can lead to your headaches getting worse. It’s important to be aware of this risk if you are using painkillers or triptans frequently. The days that you use painkillers or triptans for menstrual migraine will count towards this. Your GP can talk to you about this, including the signs to look out for and how to reduce your risk.

Contraception

Combined hormonal contraception can help to manage menstrual migraine. Combined hormonal contraception contains the hormones oestrogen and progestogen. It includes the combined pill, the vaginal ring and the contraceptive patch.

You can’t take combined hormonal contraception if you have migraine with aura, or other risk factors for stroke. If you develop migraine with aura for the first time while taking the combined pill, let your doctor know. They may advise you to switch to a different form of contraception. If you take the combined pill, taking it continuously without a break can help to prevent menstrual migraine. This avoids a sharp drop in oestrogen that may trigger your migraine. You could also try having fewer, or shorter pill-free breaks. Using an oestrogen supplement during your pill-free break can also help.

You can take the ‘mini-pill’ (progestogen-only pill) if you have migraine with aura. This can improve migraine, but it can sometimes cause prolonged, or irregular bleeding.

The intrauterine system (IUS or hormonal coil) only contains progestogen. This may sometimes stop your periods. It’s possible that this may also lead to a reduction in migraine attacks. However, there is little information about this, so more research is needed.

Hormone supplements

Oestrogen supplements are sometimes used to ‘top up’ your oestrogen levels before and during your period. These may help some people with menstrual migraine. However, the evidence on this is mixed, and there isn’t enough to be sure how well it works.

Oestrogen supplements come as skin patches or gel. You generally use them for around seven days, starting a couple of days before your period.  They will only work if your periods are regular. And sometimes they may just delay your migraine.

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

Self-management of menstrual migraine

Migraine attacks tend to result from a combination of several different triggers. It’s not always possible to identify exactly what these are. But not drinking enough, disturbed sleep and irregular or missed meals are common triggers. These may all increase your risk of a migraine attack, even in menstrual migraine.

If you have migraine linked to your periods, it’s worthwhile taking extra care to manage other migraine triggers around this time.

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.

Last reviewed: May 2025 | Next review due: May 2028