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When Migraine & Menstruation Collide

Some women may discover that their migraine attacks ebb and flow in sync with their menstrual cycle.  Known as “menstrual migraine,” the experience requires greater awareness and education, which the Department of Health and Human Services Office of Women’s Health is working to provide.  

Recognizing Menstrual Migraine 

Women are three times as likely as men to experience migraine attacks. About half of them will experience migraine related to menstruation, which may result from fluctuations in estrogen levels. These attacks are more severe and harder to treat than other migraine attacks. 

Some women see the connection between their headaches and their cycles. But others may be unaware, contributing to underdiagnosis. 

Given the likely hormonal connection with migraine disease, pregnancy can actually reduce the frequency of menstrual migraine in 90% of women. So can hormonal birth control, when taken without the placebo week that allows estrogen to drop.  

Patients are encouraged to seek treatment if they experience severe headache attacks immediately before or after the onset of menstruation (pure menstrual migraine) or at other predictable points in their cycle (menstrually related migraine). 

Treating Menstrual Migraine 

Migraine attacks triggered by menstruation can require a different treatment approach. Even medications that generally work for a given migraine patient may not work for menstrual migraine. 

Initial steps are likely to include tracking menstrual cycles and headache symptoms in a diary. Health care providers may recommend lifestyle changes, pain relievers, antidepressants, or hormonal birth control to help manage menstrual migraines. Some of these treatments, however, may also induce migraine attacks.  

Acute treatment, short-term or day-before prevention, and longer-term preventive treatments are all options. Patients who experience vomiting with menstrual migraine may be prescribed nasal sprays and injectables. Each patient’s treatment regimen depends upon symptom history, overall health, risk of side effects and responsiveness to treatment.  

Improving Awareness & Education 

The Department of Health and Human Services maintains an Office of Women’s Heath, which is an excellent source of information about menstrual migraine and migraine disease in general. The American Migraine Foundation also offers an overview of treatments that may help reduce the frequency and severity of migraine attacks.  

Whatever their trusted information source, women need to understand menstrual migraine and potential treatment options. Only then can they fully recognize the link between migraine attacks and menstruation and work with their providers to find the right treatment options.