Menstrual Migraine: Timing, Triggers & Treatment

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Menstrual migraine is a type of migraine that occurs around the time of menstrual periods. The pain can be intense and may last longer than usual. However, it can vary completely from person to person. Hormonal changes play an important role, especially the drop in estrogen levels before a period. Remembering the timing of period headaches can help people identify their symptoms and suitable treatment. 

What Menstrual Migraine Is

Menstrual migraine is a migraine attack linked to hormonal changes that occur during the menstrual cycle. It usually happens 2 days before the period and up to 3 days during the menstrual cycle. Some people may notice it only around the period, while others may have migraine attacks at other times of the month too. It may cause a throbbing headache, nausea, and sensitivity to sound or light. These symptoms can vary from person to person. Tracking down the migraine features with menstrual dates can help identify the pattern. 

Typical Timing

Menstrual migraine usually occurs between two days before the start of the menstrual cycle and the first 3 days of the period. The timing is linked with a drop in estrogen and progesterone levels before the menstrual cycle starts. 

Some people's headaches begin shortly before their periods, while for others, they begin a few days after their periods. These attacks may feel worse and more severe than the usual attacks and are less responsive to painkillers. Keeping track of your periods for at least three months can help identify the pattern. 

Hormonal And Non-Hormonal Triggers

Hormonal changes are the major reason why migraine attacks occur during menstrual cycles. But other factors can also contribute to the attacks. These triggers can vary from person to person 

Hormonal Changes Include:

• Drop in estrogen and progesterone levels 
• Menstrual cycle changes due to hormonal changes
• Starting or stopping hormonal contraceptives

Non-Hormonal Changes Include:

• Irregular sleep schedules 
• Increased stress levels
• Missed meals or dehydration
• Consuming excess caffeine and processed foods 
• Sensory triggers such as bright lights, strong smells, and loud noises.

Tracking Periods And Headaches

Keeping track of your menstrual cycles and headache days can help you understand whether your migraine is linked to hormonal changes or other factors. Try to maintain a record for at least 3 months or 3 menstrual cycles. Over time, it may help you find a pattern and provide useful information that is useful for treatment. 

What To Write In Your Diary:

• Period start and end dates.
• Headache dates, duration, and severity.
• Other symptoms such as nausea, dizziness, one-sided pain, and vomiting.
• Headache triggers, including strong smells, bright lights, missed meals, or poor sleep. 
• Medicines taken, like NSAIDs or triptans, whether they worked or not.

Tracking your symptoms cannot alone confirm the diagnosis, but it makes it easier to identify menstrual migraine and help plan suitable treatment. 

Attack Treatment Overview

According to Ayurveda, menstrual migraine is linked with vata and pitta dosha. A person with menstrual migraine may notice patterns such as Ardhvabheda, Pittaja Shirashoola, Vataja Shirashoola, and Sannipataja. Ayurvedic treatment focuses on correcting the patterns rather than only focusing on reducing pain.

• Ayurvedic therapies such as shodhana, nasya, virechana, and basti can help reduce vata and pitta dosha.
• Shirodhara is an Ayurvedic medicated liquid that is applied over the forehead to reduce headaches.
• Ayurvedic therapies, remedies, and herbs should be used under professional guidance because they may lead to serious side effects. 
• A doctor may recommend suitable pain relievers or migraine-specific medicines when symptoms occur.
• A dark room and a peaceful environment can help reduce stress and migraine attacks.
• Try to manage nausea, vomiting, and other conditions that directly trigger migraine attacks.
• If severe headaches or returning symptoms occur again and again, do not self-diagnose; try consulting a professional doctor. 

Short-Term Prevention Discussions

Short-term prevention helps reduce menstrual migraine attacks and helps make them easier to manage.

• Track your cycles for at least 3 months.
• Follow healthy habits 
• Stay hydrated
• Eat on time and don't skip meals
• Maintain a bedtime routine and get enough sleep
• Avoid spicy, oily, fermented, and processed foods
• Keep track of your personal triggers
• Try to keep your body and mind calm
• A doctor may suggest specific medications for a few days or during periods to help prevent migraine attacks.
• Consult your doctor about new or worsening symptoms, and do not start preventive medicines without professional guidance. 

Contraception, Aura And Safety

Hormonal contraception may affect migraine patterns, especially around menstruation. The safest option depends on whether you experience migraine with aura and other risk factors.

• Combined hormonal contraceptives containing oestrogen are generally not recommended during migraine with aura because they can increase the risk of stroke. 
• Some hormonal contraceptives such as mini-pills, hormonal IUDs, the implant and injections may be suitable depending on the individual’s risk factors. 
• Discuss your migraine symptoms before changing, starting, or stopping your contraceptives with your doctor. 
• Recognise new signs such as weakness, difficulty speaking, or sudden vision loss as they require urgent medical care. 

Pregnancy Planning

If you're experiencing migraine and planning a pregnancy, it is important to review your treatment beforehand. Hormonal changes during pregnancy may affect migraine attacks, their duration, and severity.

• Check with your doctor beforehand and review your medicines, as some medicines are not safe during pregnancy. 
• Discuss suitable options for preventing and managing migraine attacks.
• Monitor your daily habits, get enough sleep, eat healthy meals, and do exercise if recommended.
• Consult your doctor before using any Ayurvedic herbs or medicines.
• Seek emergency help if you notice severe headaches or discomfort when standing.

When Bleeding Or Headache Symptoms Need Review

Changes in menstrual cycle or migraine symptoms may sometimes point to problems that need medical attention. It is important to notice when something feels different from your usual symptoms. 

Seek Immediate Medical Help If You Notice:

• Heavy bleeding
• Sudden changes in menstrual cycles
• Worsening headaches
• New or unfamiliar symptoms
• Weakness and numbness
• Trouble speaking
• Vision loss or blurred vision 

Iron Deficiency 

Heavy menstrual bleeding can lead to iron deficiency. It can cause tiredness, weakness, dizziness, and severe headaches. Low oxygen flow to the brain alters serotonin and dopamine, which can trigger or worsen migraine attacks. If you feel weak, pale, or tired during your menstrual cycle, you may consult a doctor. Doctors may recommend tests such as CBC (complete blood count), hemoglobin, and serum ferritin to test iron levels. Avoid taking iron supplements without medical advice because not all supplements are suitable for everyone. Managing heavy bleeding and migraine attacks can help improve your overall health. 

Reference 

Menstrual migraine: a review of current and developing pharmacotherapies for women - PubMed

Is iron deficiency anemia related to menstrual migraine? Post hoc analysis of an observational study evaluating clinical characteristics of patients with menstrual migraine - PubMed

Iron Deficiency Anemia Is Associated with Menstrual Migraine: A Case-Control Study - PubMed

Effect of Migraine on Pregnancy Planning: Insights From the American Registry for Migraine Research - PubMed

Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence - PMC

Short-term prevention of perimenstrual migraine with rimegepant - PMC