If you think migraines timed to your menstrual cycle are something you suffer from month after month, think again.
“Menstrual migraines are a common occurrence, and there are very helpful treatments to make this a more comfortable time,” says Huma U. Sheikh, MD, headache specialist and CEO of New York Neurology Medicine.
How do I know if it is menstrual migraine?
If your migraine starts anywhere between 2 days before your period and 3 days after, you have a menstrual migraine. But you can also get migraines at other times, for example during ovulation, says Sheikh.
Menstrual migraine attacks are usually more severe and last longer. And around this time you are usually more sensitive to light than during other migraine attacks.
If there seems to be a connection between migraine attacks and your menstrual cycle, hormones are likely the cause. “Using a headache diary or app can be helpful to determine if there is a clear pattern,” says Sheikh.
Why do I get migraines during my period?
It’s all about hormones. “Over the course of a normal cycle, your estrogen levels rise until about day 14 of your cycle,” says Steven A. Rabin, MD, a gynecologist in Burbank, CA. That’s when you start to ovulate and produce more progesterone.
Around day 27 or 28, both hormones drop back to normal levels. “The sudden drop in estrogen can trigger migraine headaches in many women,” says Rabin.
What helps with menstrual migraines?
There are many ways to treat and treat your menstrual migraines. These include mini-preventive treatment, acute treatment and hormonal treatment.
Mini preventive treatment
Sometimes you can stop menstrual migraine attacks before they start, or reduce their severity with prevention techniques.
“This is called mini-prophylaxis or mini-prevention, or taking medications daily or regularly around the menstrual cycle,” says Sheikh.
One option is to take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or fenoprofen calcium (Nalfon), twice daily for 5-7 days. Do this 2-3 days before your period starts and throughout the period.
Another option is estrogen supplementation. You can use a pill, vaginal gel, or patch before and during your period to stop the natural estrogen dip that causes migraines.
“We give patients a very low dose of plant-based natural estradiol,” says Rabin. It comes in the form of a prescription patch. Each month, you apply the patch to your skin about one day before your migraine usually occurs.
“It’s important to track your cycle and find this day so you can get what I call the estrogen parachute, which keeps your estrogen levels from falling off a cliff and causing migraines,” says Rabin. You wear it for about 3-4 days and then take it off.
Other mini prevention techniques include taking magnesium starting on day 15 of your cycle and taking triptans twice a day during your period.
If you are in the middle of a menstrual migraine attack, you can take medications to ease the pain. It is most effective if you take it early.
Your doctor may recommend a fast-acting triptan or a selective serotonin receptor agonist. Most triptans are pills. Some are available as an injection under the skin or as a nasal spray and powder.
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex, Tosymra)
- Zolmitriptan (Zomig)
Your doctor may also suggest that you take an NSAID along with the triptan. A multiple-treatment approach can also help, Sheikh says. For example, you take a pain reliever and use a heating pad at the same time to manage other menstrual symptoms.
CGRP (calcitonin gene-related peptide) antagonists are another option. CGRP is a molecule involved in causing migraine pain. CGRP antagonists block the effects of CGRP. They include rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy).
If you have tried other methods and they don’t work, or if your periods are irregular, your doctor may recommend continued preventative treatment.
One form of ongoing prevention is taking the birth control pill every month without breaking. Instead of taking a placebo pill for 7 days, you continue to take active pills. This keeps your hormones from dropping and causing migraines. You can also do this with a vaginal ring. After you remove the ring, put a new one in right away, instead of waiting until your period is over.
Your doctor may recommend medications that alter hormone levels, such as leuprolide (Lupron). Or they may suggest using the lowest possible dose of estrogen in your hormonal birth control.
Botox is also a good option. It is FDA-approved for migraines and works by blocking pain signals in the nerves. It may take some time to work, so you may need more than one treatment. Your doctor may prescribe this if other preventive treatments don’t work.
Neuromodulation treatments can be used during an attack or to prevent it. They send signals to your brain and nervous system using electrical or magnetic waves or heat to calm brain activity. Some are portable; others are surgically implanted.
What should I avoid?
You can better manage your pain by avoiding triggers or things that make you feel worse. Try keeping a migraine diary to identify triggers and sensitivities. Alcohol, dehydration and stress are common. Heat and light can make you feel worse.
Avoid alcohol around your period. Try to drink 1.5-2 liters of water every day. If you have light or heat sensitivity, try to stay in a cool, dark room.
Can lifestyle choices help menstrual migraines?
“Regular exercise and a healthy diet have been shown to reduce overall menstrual symptoms and can help with migraine attacks,” says Sheikh. A good, consistent sleep schedule can also help. Try to limit coffee and energy drinks if they cause sleep problems.
Learn to deal with stress better. Try relaxation techniques. “Yoga and mindfulness can be a really useful tool to help regulate your hormones and make this time easier,” says Sheikh.
Which menstrual migraine treatment is right for me?
Your doctor can help you decide which options are best for you. It may be a combination of strategies including mini-prevention, acute treatment and lifestyle changes. Or they may recommend continuous contraception.
“You have many convenient options and most of them are safe,” says Sheikh. But everyone is different and it depends on many factors. “It’s important to take an individual approach,” she says.