Menstrual Migraine

There is little difference in migraine prevalence between males and females before puberty, but post-puberty, migraine disproportionately affects women. In many females, migraine is associated with the changes in female hormones that accompany the menstrual cycle; in fact, up to 2/3 of women report worsening migraine during their period. Menstrual migraine can be more severe and debilitating than typical migraine, lasting longer and featuring a wider array of symptoms.

What Causes It?

According to the estrogen withdrawal hypothesis, the rise and fall of estrogen during the menstrual cycle is responsible for the increased frequency and severity of migraine attacks. Estrogen levels drop suddenly in the days just before menstruation, triggering a greater risk of migraine during this period, for reasons not yet fully understood. 

However, animal studies indicate that brain areas involved in migraine generation have a number of estrogen receptors, which may suggest a pathway for migraine.

What Are the Symptoms?

Menstrual migraine occurs just before or during the start of a woman’s period, and may cause typical migraine symptoms, including aura before head pain begins, the classic throbbing pain on one side of the head, nausea and vomiting, and/or sensitivity to light and sound.

How Is It Diagnosed?

Clinicians often evaluate several criteria to identify if a woman’s migraine is related to hormonal fluctuations, including:

  • If the migraine occurs up to two days prior, or two days following, the first day of menses 
  • If an estrogen-progestin contraceptive affects or triggers the migraine
  • If the subject has recently changed contraceptives

How Is It Treated?

Menstrual migraines can be much more severe than regular migraines and often do not respond as well to treatment. Medications that may help include prescription triptans or over-the-counter analgesics like NSAIDS (acetaminophen, ibuprofen or naproxen).

Is It Preventable?

Continuous dosing with estrogen contraceptives (in other words, without interim placebo) can help to avoid the drop in estrogen levels that occurs during the menstrual cycle and potentially avert menstrual migraine.

What Causes It?

According to the estrogen withdrawal hypothesis, the rise and fall of estrogen during the menstrual cycle is responsible for the increased frequency and severity of migraine attacks. Estrogen levels drop suddenly in the days just before menstruation, triggering a greater risk of migraine during this period, for reasons not yet fully understood. 

However, animal studies indicate that brain areas involved in migraine generation have a number of estrogen receptors, which may suggest a pathway for migraine.

What Are the Symptoms?

Menstrual migraine occurs just before or during the start of a woman’s period, and may cause typical migraine symptoms, including aura before head pain begins, the classic throbbing pain on one side of the head, nausea and vomiting, and/or sensitivity to light and sound.

How Is It Diagnosed?

Clinicians often evaluate several criteria to identify if a woman’s migraine is related to hormonal fluctuations, including:

  • If the migraine occurs up to two days prior, or two days following, the first day of menses 
  • If an estrogen-progestin contraceptive affects or triggers the migraine
  • If the subject has recently changed contraceptives

How Is It Treated?

Menstrual migraines can be much more severe than regular migraines and often do not respond as well to treatment. Medications that may help include prescription triptans or over-the-counter analgesics like NSAIDS (acetaminophen, ibuprofen or naproxen).

Is It Preventable?

Continuous dosing with estrogen contraceptives (in other words, without interim placebo) can help to avoid the drop in estrogen levels that occurs during the menstrual cycle and potentially avert menstrual migraine.

Sources

  1. The Journal of Family Planning & Reproductive Health Care. Menstrual migraine: a clinical review. https://pubmed.ncbi.nlm.nih.gov/17389095/
  2. Headache. A prospective comparison between ICHD-II and probability menstrual migraine diagnostic criteria. https://headachejournal.onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fhead.14152&key=20236338
  3. Migraine Disorders. How Hormones Impact Migraine Part 1 - Spotlight on Migraine: The Professional Series. https://www.youtube.com/watch?v=L0svqxME3Nc
  4. The Journal of Headache Pain. Male and female sex hormones in primary headaches. https://pubmed.ncbi.nlm.nih.gov/30497379/
  5. The Journal of Headache Pain. Estrogen receptors α, β and GPER in the CNS and trigeminal system - molecular and functional aspects. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653779/
  6. UpToDate. Estrogen-associated migraine, including menstrual migraine. https://www.uptodate.com/contents/estrogen-associated-migraine-including-menstrual-migraine

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