Menstrual or Hormonal Migraine

Migraine is closely associated with hormones. Some women find their migraines start at puberty, and are linked to their menstrual cycle. The additional hormonal trigger for women may explain why more women than men experience migraine during their reproductive years. Menopause is often the most difficult time for women with migraine. Postmenopause many women find their migraine eases, while men of a similar age find their migraine gets worse. While many report menstruation is a trigger, there is also a specific diagnosis of menstrual migraine. This kind of migraine is believed to affect around 60% of women who have migraine, or up to 10% of all women.

Symptoms and Diagnosis

Menstrual migraine is associated with falling levels of oestrogen. It is most likely to occur in the two days leading up to a period as well as the first three days of your period.

There is no test available, you can only figure it out by keeping a migraine diary that includes the days you menstruate.

Treatment

If you get menstrual migraine, a low dose or estrogen-free birth control option (including long-acting reversible contraceptive solutions that can stop periods altogether like Mirena IUDs, and Depo Provera shots) may be a good option.

A combined oral contraceptive pill that includes estrogen is another option, however, if you have migraine aura, you should discuss this carefully with your neurologist (and gynaecologist or GP), as your risk of stroke is higher, and the combined pill can significantly increase the risk of stroke. The combined pill can also make migraine worse in some women.

If you have migraine and heavy periods, taking Ponstan could help. Mefenamic acid is considered to be helpful in reducing migraine associated with heavy and/or painful periods. A dose of 500 mg can be taken three to four times daily. It can be started 2 to 3 days before the expected start of your period. If your periods are not regular, it is often effective when started on the first day. It is usually only needed for the first two to three days of your period.

Naproxen (Naprogesic) can be effective in doses of around 550 mg once or twice daily around the time of menstruation. Other NSAIDs (non-steroidal anti-inflammatories, for example, Nurofen) taken twice a day around your period can also decrease or eliminate menstrual migraine attacks.

Magnesium, taken from the 15th day in your cycle until your period starts, may also be beneficial.

Normal migraine medications like Triptans may also work for your menstrual migraine.

Any plan to manage your migraine should be worked out with your doctor.

Read more about menstrual migraine at The Migraine Trust or the American Migraine Foundation.

Megan Menstrual Migraine, Regional SA

I’ve experienced migraine attacks since a young age. As I got older, they got progressively worse. When I finally sought help, I learnt it was Menstrual Migraine. Every month I would suffer from debilitating migraine symptoms. Since being diagnosed, I have switched my contraceptive pill and I also have medication to help me manage my attacks.

Useful links:

Factsheet: Migraine and Hormones

Clinically reviewed by Dr Nicole Limberg MBBS, FRACP