Menstrual Migraines and Hormones in Women

Does it seem like you always get migraines right around your period? You’re not imagining that the two are linked. About 60 percent of women get a type of headache called menstrual migraines.

Right before your period, the amount of estrogen and progesterone, two female hormones, in your body drops. This drastic change can trigger throbbing headaches.

Some types of birth control pills can also play a role. Three weeks out of every month, they keep the hormones in your body steady. When you take placebo pills or no pills at all, during the week of your period, your estrogen levels plummet and your head can pound.

If you’re prone to menstrual migraines, taking birth control that contains low amounts of estrogen or only progesterone may help.

Hormone replacement therapy, a type of medicine women take during menopause to control their hormones, can also set off menstrual migraines.

Treatment

A nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen is sometimes all you need to treat a menstrual migraine. You can buy these over the counter, or your doctor can prescribe a stronger version. Along with your migraine symptoms, these drugs can also relieve period cramps.

Triptans are another option. These drugs block pain signals in your brain. They can start to work as soon as 2 hours after you take them.

Your doctor may suggest that you take both an NSAID and a triptan to get relief.

If your period comes every month like clockwork, you can start these drugs a few days before your bleeding starts and continue for 2 weeks. If your period doesn’t always stick to a schedule, your doctor may suggest you try a drug that will prevent a headache from happening in the first place.

Prevention

Some birth control methods like pills, patches, and vaginal rings may help lower the number of menstrual migraines you have or make them less severe. But they don’t work for everyone. In some cases, they could make your migraines worse.

Your doctor might tell you to stay on birth control for 3 to 6 months without taking any placebo pills. This will prevent you from having a period and may stop your headaches.

Continued

If you get migraines with auras, using birth control that contains estrogen and progesterone isn’t a safe option. Taking it could make you more likely to have a stroke. Other reasons your doctor may not want you to take birth control for your menstrual migraines:

The drugs used most often to treat menstrual migraines can also help prevent them. These include NSAIDs and triptans, such as:

Your doctor may also prescribe a drug that’s often used to treat other conditions. These could include beta-blockers, which help control high blood pressure, anti-seizure drugs, or antidepressants.

Alternative therapies could also give you some relief, although it’s key that you check with your doctor before you try one. Magnesium supplements help some women with menstrual migraines. Acupuncture, relaxation exercises, and biofeedback therapy are useful, too.

Eating too many salty foods could also lead to headaches. It’s wise to limit the amount of salt you eat around the time of your period. Taking “water pills” (your doctor might call them diuretics) can help.

If nothing else works, your doctor may prescribe a drug called leuprolide acetate (Eligard, Lupaneta Pack, Lupron Depot). It drops the estrogen levels in your body, but it does have side effects. Because of this, it’s often thought of as a last resort.

Pregnancy Concerns

During the first trimester, estrogen levels rise quickly, then level out. Because of this, many women notice that their migraines get better or go away after their third month of pregnancy.

If you still get headaches, don’t take any drugs. Many migraine medicines are bad for your baby. An over-the-counter pain reliever like acetaminophen is generally believed safe, but check with your doctor before you take it.

Menopause

In the years before menopause, estrogen levels go on a rollercoaster ride. Many women see their headaches get worse during this time.

Once you stop having periods for good, your migraines will likely stop as well. If you’re on estrogen replacement therapy and your headaches get worse, your doctor may lower the dose, advise you to stop taking it, or change to a different type.

An estrogen patch is often the best option. It keeps your estrogen level steady, so a menstrual migraine is less likely to happen.

WebMD Medical Reference Reviewed by Lawrence C. Newman, MD on June 20, 2017

Sources

SOURCES:

National Headache Foundation: “Cut Back on Salt to Decrease Headaches,” “Menstrual Migraine.”

Mayo Clinic, “Chronic Daily Headaches,” "Headaches and hormones: What’s the connection?”

Harvard University: “Taming the Cycle: How Does the Pill Work?”

OBG Management: “The gynecologist’s role in managing menstrual migraine.”

Cleveland Clinic: “Hormone Headaches Menstrual Migraines.”

The Migraine Trust: “Migraine and the contraceptive pill,” “Supplements and herbs.”

American Family Physician: “Contraception Choices in Women with Underlying Medical Conditions.”

UpToDate: “Patient education: Migraine headaches in adults (Beyond the Basics).”

American Headache Society: “Menstrual Migraine.”

Drug Safety: “Migraine in pregnancy: What are the safest treatment options?”

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