The days before and during your period can be pretty uncomfortable. Bloating, cramps, irritability, fatigue, and headaches are just some of the symptoms that are par for the course prior to and during that time of the month. But for some people who have periods, associated symptoms can be especially severe. If your head is throbbing in the days before your period, in addition to nausea, dizziness, blurry vision, or all three, you may have what’s called menstrual migraine.
If you get these types of migraines, you aren’t alone. According to the National Headache Foundation, more than 60 percent of women who have migraines experience them along with their period. Treating a menstrual migraine is different from managing other types of period pain. Allure spoke to two doctors about how to identify menstrual migraines as well as how to find relief.
What are period migraines?
First thing’s first: You may get torturous headaches during your period, but that doesn’t mean they are migraines. Dr. Holly L. Phillips, an internist who practices in New York City, says that more than 90 percent of headaches fall into the category of tension-type headaches. Far fewer people actually experience true migraines. Statistics published in Cephalalgia state that 11 percent of people worldwide get migraines, while tension-type headaches are far more common. There’s also a socio-economic link to your risk for any type of migraine, with people from lower-income households experiencing migraines at higher rates, likely due to more stressors that can trigger them.
There seems to be some confusion about what migraines really are and it often involves the level of pain. “We tend to think of migraine as causing more severe pain than other types of headaches, but that’s not always the case,” says Phillips.
You can spot the difference between a menstrual migraine and a premenstrual syndrome (PMS) headache by taking careful note of your symptoms. According to the Mayo Clinic, migraine headaches typically last anywhere from four hours to three days. Migraines are characterized by throbbing pain, usually on one side of your head, in addition to other symptoms. You may also have severe nausea that can cause vomiting.
Other symptoms of menstrual migraines may include:
- Sensitivity to light, sound, and smells
- Disturbances in your field of vision, known as migraine aura
- Dizziness and exhaustion, even after the pain subsides
What causes period migraines?
A quick biology refresher for people with periods: Though most people only bleed for three to five days, your body goes through the menstrual cycle all month long. The levels of both estrogen and progesterone drop off sharply at the end of each monthly cycle, signaling to your body that it’s time to reset your cycle and begin your period. Dr. Lucky Sekhon, a New York City-based, board-certified OB-GYN and fertility specialist, tells Allure that migraines that show up two or three days before your period can be triggered by this steep hormone drop.
If you switched birth control and began to experience menstrual migraines shortly after, that switch may be the culprit. It’s possible that a higher dose of estrogen in your birth control pills can make the hormone drop even steeper. “Sometimes, all that is required to improve or prevent migraines is switching to a pill with a lower estrogen content,” says Sekhon.
A 2013 literature review published in the Journal of Headache and Pain suggests that people who have migraines might even want to stick to progestin-only pills if they are going to use an oral contraceptive. (However, it’s worth noting that the review’s authors concluded that more clinical trials were needed to establish firm contraceptive recommendation guidelines for people who have migraines. Phillips says that some people’s migraines get better when they take hormonal birth control, while other people’s migraines get worse.)
And menstrual migraines may be worse for people who are approaching menopause. (One study noted that the peak prevalence for all migraines happens for women in their late 30s; the average age for starting the menopause transition is between 45 and 55.)
These migraines tend to run in families, but Sekhon says that researchers are still working to understand those genetic components. Since menstrual migraine is not uncommon, it’s statistically likely that one of your immediate family members will have the condition, so a family history doesn’t necessarily give us insight into whether or not you would have the condition. A 2004 study published in the Journal of Neurology found that participants with menstrual migraines were more likely to have two or more relatives who also have migraines compared to the control group of participants who didn’t get menstrual migraines, but the sample size was small.
What are the treatment options for period migraines?
The good news is that there are plenty of treatment options if you’re having period-related migraines. The first line of treatment recommended typically involves things you can try at home. “Always, my first approach is to minimize lifestyle triggers that could be exacerbating the migraines outside of hormones,” says Phillips, such as avoiding stress (as much as possible), cutting out foods that you already know can trigger your migraines, correcting irregular sleep patterns, and staying away from second-hand smoke.
Sekhon takes a similar approach. “I would start with lifestyle alterations: improving sleep hygiene, nutrition, staying well-hydrated, eating regular meals, getting regular exercise, and avoiding triggers such as alcohol and certain foods that make it worse,” she says. She also recommends tracking what you eat and drink, as well as your activities so that if you do get a migraine, you can identify (or rule out) potential triggers. Over-the-counter, nonsteroidal anti-inflammatory drugs, like naproxen or ibuprofen, can treat menstrual migraines and also help reduce pain from cramps.
If doing these things isn't enough, it may be time to chat with your doctor. They can help you figure out the best course of action to take. According to Phillips, some patients take prescription-strength triptans a few days before their period starts to prevent or reduce migraine symptoms. “Hormonal therapy with oral contraceptives or an estrogen patch might provide relief,” says Phillips.
For the most severe migraine pain and nausea, Sekhon says, your doctor may prescribe nerve blockers or anti-nausea medication.
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