Headache: Menstrual

Menstrual migraines, also called "hormone headaches", are a type of migraine headache that occur in response to changes in hormone levels during the menstrual cycle. Menstrual migraines affect 60% of women. (Migraines, in general, occur three times more frequently among women than men)

Menstrual migraines may occur before, during or immediately after a woman's period, or during ovulation.

Although they can occur at different times during the menstrual cycle, a woman will usually experience her menstrual migraine at the same phase each month.

Serotonin, a neurotransmitter in the brain, is the primary hormonal trigger of all migraine headaches. Research suggests that migraine headaches are an inherited disorder affects the way serotonin is used in the body. For women with menstrual migraines, serotonin levels may be impacted by fluctuations in other female hormones, such as estrogen. Because oral contraceptives influence estrogen levels, women on birth control pills may also experience  menstrual migraines. (Though some women report having fewer menstrual migraines while taking birth control pills.)

Menstrual migraine treatment

Women with menstrual migraines are treated with "acute medications". When attacks are very frequent, severe, or disabling, women may also benefit from use of a "prevention medication".

Your doctor will recommend a treatment based on the severity and frequency of your headaches, and your past response to other treatments.

Acute Medications

Medications that are commonly used for the acute treatment of menstrual migraine include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Dihydroergotamine (DHE)
  • A combination of aspirin, acetaminophen, and caffeine (AAC)
  • Triptans

Preventive Medications

Women with very frequent and/or severe menstrual migraines are candidates for preventive medications to prevent attacks. Short-term use of the following preventive medication take just before menstruation can be effective.

  • Naproxen sodium (or another NSAID)
  • Triptans, such as frovatriptan
  • DHE
  • Magnesium, equivalent to 500 mg twice a day.
  • Fluoxetine (Prozac®, Sarafem®) especially if the headache is associated with other premenstrual dysphoric disorder (PMDD) symptoms, can be an effective headache preventive between ovulation and menses.

If the migraines break through the preventive medication around the time of menstruation, the dose can be increased just prior to menstruation.

Hormonal Therapy

If standard preventive measures are unsuccessful at controlling menstrual migraines, hormonal therapy may be indicated. This may involve the use of a supplemental estrogen taken prior to, and during menstruation.  Estradiol (0.5 mg tablet twice a day, or 1 mg patch) is the most common form of estrogen prescribed because it does not convert to the other active forms of estrogen.

For women using traditional oral contraceptives with estrogen and progesterone for 21 days per month, the supplemental estrogen may be started on the last day of the pill pack.

Another approach for women who take an estrogen/progesterone oral contraceptive is to take it daily without the monthly break for 3 to 6 months. The reduction in menstrual periods provides a method of preventive treatment. You will need to discuss the risks and benefits of this option with your doctor.

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© 2010 Vivacare. Last updated March 17, 2011.

Reference: National Institute of Neurological Disorders and Stroke (NINDS)

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Additional Resources

Overview
Hormones and Migraines (NHF) (link to National Headache Foundation)
Menstrual Migraine Overview (NHF) (link to National Headache Foundation)
Background
Treatment Summary
Medications
Related Conditions
Self Care
More Information
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