It has been estimated that 70% of migraine sufferers are female. Of these
female migraine sufferers, 60%-70% report that their migraines are related to
their menstrual cycles -- hence the name, menstrual migraines.
What Is the Relationship Between Hormones and Headaches?
Headaches in women, particularly migraines, have been related
to changes in the levels of the female hormone estrogen during a woman's
menstrual cycle. Estrogen levels drop immediately before the start of the
Premenstrual migraines regularly occur during or after the time
when the female hormones, estrogen and progesterone, decrease to their lowest
Migraine attacks typically disappear during pregnancy. In one
study, 64% of women who described a menstrual link to their headaches noted
that their headaches disappeared during pregnancy. However, some women have
reported the initial onset of migraines during the first trimester of
pregnancy, with disappearance of their headaches after the third month of
What Triggers Hormonal Migraines in Women?
Birth control pills as well as hormone replacement therapy
during menopause have been recognized as migraine triggers in some women. As
early as 1966, investigators noted that migraines can become more severe in
women taking birth control pills, especially those containing high doses of
The frequency of side effects, such as headache, decreased in
those who took birth control pills containing lower doses of estrogen and did
not occur in those who took birth control pills containing progesterone.
What Are the Treatment Options for Menstrual Migraines?
medications of choice to stop a menstrual migraine are nonsteroidal
anti-inflammatory medications (NSAIDs).
The NSAIDs most often used for menstrual migraines include:
Advil and Motrin
NSAID treatment should be started two to three days before the
menstrual period starts and continued until the period ends. Because the
therapy is of short duration, the risk of gastrointestinal side effects is
For people who have severe menstrual migraines or who want to
continue taking their birth control pills, doctors recommend taking a NSAID,
starting on the l9th day of the cycle and continuing through the second day of
the next cycle.
Other drugs that may be used are given by prescription only.
Small doses of ergotamine drugs (including Bellergal-S, Cafergot,
Beta-blocker drugs such as propranolol
Anticonvulsants such as valproate (Depakote)
Calcium channel blockers such as verapamil
These drugs should also be started two to three days
pre-menses, and continued throughout the menstrual flow.
Because fluid retention is often associated with a woman's
period, diuretics have been used to prevent menstrual migraine. Some doctors
may recommend limiting salt-intake immediately before the start of menses.
Lupron is a drug that affects hormone levels and is used only
when all other treatment methods have been tried and have been