Types Of Headaches Hormonal Headaches Menstrual Migraines

Women are much more likely to develop migraines than men, and up to seventy percent of female migraine sufferers report some correlation between migraine frequency and their menstrual cycles. This has lead some migraine researchers to speculate that changes in levels of female sex hormones may explain why women are more susceptible to migraines than men.

Menstrual Headaches - Hormonal Headaches - Types of Headaches

Defining the True Menstrual Migraine

Women report that migraine frequency rises just before, during, and after their menstrual period. Researchers have been unsure how to classify true menstrual migraines. After all, as menstruation occurs an average of four to five days every month, the law of averages dictates that some headaches and migraines that occur during these days will not be connected to the menstrual cycle.

Currently, a true menstrual migraine is classified as a predictable event that occurs every month between the second day of menses and the end of menstruation. Migraines occurring during the PMS period of the cycle are not considered true menstrual migraines, and are classified as “hormone headaches.” Approximately fourteen percent of women experience true menstrual migraines. Some women experience migraines only during their menstrual period, and are headache-free the rest of the month.

Symptoms of a Menstrual Migraine

A menstrual migraine has symptoms similar to a regular migraine. Like other migraines, menstrual migraines are one-sided headaches that are often aggravated by bright light and loud noises. The migraine may trigger nausea, and may present with or without aura.

Women report that menstrual migraines occur more frequently than other migraines, last longer, and have more severe symptoms. Researchers are divided on this: Some believe menstrual migraines are no more or less common then other migraines. They believe that other menstrual symptoms, such as stomach cramps, may amplify migraine symptoms making a menstrual migraine harder to endure than migraines occurring at other times of the month.

A recently published article in Neurology , however, indicates that menstrual migraines do indeed occur more frequently than other migraines – an average of 2.5 times more often. The same article noted that women were three times as likely to rate menstrual migraine symptoms as severe when compared with other migraines.

Menstrual Migraine, Estrogen, and Migraine Triggers

Levels of the female sex hormones estrogen and progesterone drop significantly just before the menstruation begins. This has led researchers to speculate that estrogen levels are connected to menstrual migraines. In fact, the results of a recent study at the Norwegian National Headache Center in Norway have shown that women who take estrogen-containing birth control pills are more likely to experience menstrual headaches than women not taking the pill.

Research has revealed that low dose estrogen treatment started when estrogen levels drop can prevent menstrual migraines, at least until estrogen therapy ends.

While this certainly suggests an association between estrogen and menstrual migraine, it may be too simplistic to claim low estrogen levels alone cause menstrual migraines. Menstruation causes many different hormonal and chemical changes. For instance, estrogen levels directly influence serotonin levels. Serotonin is a brain chemical (a neurotransmitter) that plays a significant role in headache and migraine pain.

Prostaglandins are substances that heighten pain receptor sensitivity and which cause cerebral blood vessel inflammation. Levels of prostaglandins rise during menstruation so may also be culprits in menstrual migraines. Prostaglandins’ ability to sensitize pain receptors may also explain why women report menstrual migraines as more severe than other migraines.

Menstrual Migraine Treatments

Treatments for menstrual migraines are either acute or preventive. Acute menstrual migraine treatments provide relief as the menstrual migraine occurs. Acute medications include ergotamine and triptans, as well as over the counter non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

Preventive treatments reduce the severity of menstrual migraines. Few clinical studies have specifically examined menstrual migraines, so most preventive treatment is based on what works for other migraines. Preventive treatments include:

  • anticonvulsants
  • beta blockers
  • calcium channel blockers
  • NSAIDs
  • tricyclic antidepressants
  • triptans and other serotonergic medications.

When taking preventive medication, follow your doctor’s dosage and usage instructions faithfully. Overuse of many medications used to treat menstrual migraine can result in rebound headaches.

If all other treatments fail, hormone replacement therapy may be prescribed for menstrual migraine prevention. Either oral estrogen or an estrogen patch is employed during menstruation to prevent migraines.




American Council for Headache Medication. (updated 2001). Menstrual headache.

Fettes, I. (1997). Menstrual migraine: Methods of prevention and control.

Gordon, S. (2004). Menstrual migraines hit hard.

Jelovsek, F. (nd). Menstrual migraine headaches.

Lichten, E. (updated 2000). Menstrual migraine: Hormonal considerations of migraine management in reproductive age women.

Aegidius, K., Zwart, J.A., Hagen, K., Schei, B.