Menstrual Migraines – Causes, Symptoms, and Treatment…

Menstrual Migraines – Causes, Symptoms, and Treatment…

Many women report an increase in the frequency of migraine headaches in occurrence with the perimenstrual period. Many patients that I have seen used to call any severe headache they had a ‘migraine headache’. However, migraine headaches have some unique qualities which distinguish them from other headaches such as tension headaches.

For many women, the monthly arrival of their menstrual cycle can bring not only discomfort but also the dreaded menstrual migraine. Menstrual migraines are a subset of migraines that occur in relation to the menstrual cycle. These headaches can be incredibly debilitating, disrupting daily life and causing significant pain. In this blog, we’ll delve into the world of menstrual migraines, exploring their causes, symptoms, triggers, and effective management strategies.

What Are Menstrual Migraines?

Menstrual migraines, also known as menstrual-related migraines (MRMs) or hormonally-triggered migraines, are a specific type of migraine headache that occurs in a predictable pattern related to the menstrual cycle. These migraines are typically experienced by women who have a history of migraines, and they often begin 2 days before menstruation, during menstruation, or in the first three days after menstruation ends.

Causes and Triggers

  1. Hormonal Fluctuations: The primary trigger for menstrual migraines is the hormonal fluctuations that occur during the menstrual cycle. Estrogen, in particular, is believed to play a significant role. A drop in estrogen levels, which happens just before menstruation begins, can trigger these migraines.
  2. Sensitivity to Hormonal Changes: Some women may be more sensitive to hormonal changes, making them more susceptible to menstrual migraines. It is not entirely clear why some women experience this sensitivity while others do not.
  3. Genetics: There may be a genetic component to menstrual migraines. If you have a family history of migraines, you may be more likely to experience them during your menstrual cycle.


The symptoms of menstrual migraines are similar to those of regular migraines and can include:

  • Intense, throbbing headache
  • Nausea and vomiting
  • Sensitivity to light and sound
  • Visual disturbances (aura) in some cases
  • Dizziness
  • Fatigue

What Are the Symptoms of Migraine Headaches?

  1. Migraine headaches are most commonly on one side of your head vs tension headaches which are bilateral.
  2. Migraine headaches often have a throbbing quality.
  3. Migraine headaches are often accompanied by either sensitivity to noise, light, smell, or various combinations of these.
  4. Migraine headaches are often preceded by a prodrome which can include a change in mood or fatigue.
  5. Many patients who have migraine headaches often notice that it is preceded by an aura which can include blind spots in their vision called scotomas, or they may see flashing colorful lights.
  6. Migraine headaches often include Nausea/vomiting as a symptom.

What Causes Menstrual Migraines?

Estrogen fluctuations, in particular, their premenstrual fall, are generally regarded as the main triggers of menstrual migraine.

Treatment Options:

“Acute management of menstrual migraine should initially be abortive and primarily sought with triptans. If this fails, short-term perimenstrual prophylaxis with NSAIDs, coxibs, triptans or ergotamine derivatives can be considered. Hormone manipulations, mainly application of percutaneous estradiol gel in PMP or administration of oral contraceptives in extended cycles, constitute an alternative approach for nonresponders” (Allais et al, 2007).

Summary from Allais et al:

  1. Triptans–e.g. Sumatriptan–selective serotonin 5-HT1B/1D agonists.
  2. NSAIDS–Non-steroidal Anti-Inflammatory Drugs, e.g. naproxen, ibuprofen.
  3. Ergoatamine–e.g. Cafergot (with caffeine).
  4. Percutaneous Estradiol gel for non-responders.


  1. Allais G, Castagnoli Gabellari I, De Lorenzo C, Mana O, Benedetto C. Menstrual migraine: clinical and therapeutic aspects. Expert Rev Neurother. 2007 Sep;7(9):1105-20.
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