Menstrual Migraines

Menstrual irregularities are cause for serious discomfort for many women. One of the highly prevalent distresses associated with menstruation are migraines. It has been found that 67% of premenopausal women who suffer from migraines report attacks with their menstrual cycle. Most of these migraines are associated with an aura. There are two subtypes of menstrual migraines according to the International Headache Society: menstrually related migraine with without aura and pure menstrual migraines. Estradiol, the form of estrogen most imperative in female reproduction, has been pinpointed as the trigger for these attacks. Two other pathophysiologies are: 1) release of prostaglandins from the shedding endometrium that sensitizes peripheral nociceptors, 2) decrease serum magnesium, and 3) declining levels of inhibitory neurotransmitter systems (i.e. GABA) modulate neuronal firing rates. Both acute as well as preventive therapies have bene researched and found.

Steady levels of estrogen are effective in treating headaches, but fluctuating levels between high and low will exacerbate headaches. Treatment for acute migraine attacks are:

  • Analgesics with or without prokinetic antiemetics
  • NSAIDs – may also be preventive
  • Abortive therapies
    • Ergot derivatives
    • Triptans (i.e. sumatriptans)
  • Acetaminophen
  • Aspirin
  • Caffeine
  • Estradiol
  • Apply ice
  • Relaxation exercise
  • Acupuncture
  • Prophylactic
    • Short-term
      • NSAIDs
      • Triptans
      • Estrogen transdermal patches/gel
      • Naproxen (Ibuprofen)
    • Continuous
      • Hormonal
        • Long duration oral contraceptives
        • Gonadotropin releasing hormone agonists (GnRHa)
      • Non-hormonal
        • Beta-blockers (anti-arrhythmic)
        • Calcium-channel blocker (anti-arrhythmic)
        • Tricyclic antidepressants
        • Anticonvulsants
      • Prescription medication for pain prescribed by physician.

One very effective treatment also involves using birth control pills because they help regulate the hormonal levels in your bloodstream all month long. Moreover, women who have menstrual migraines may have intensified attacks when they are menopausal. If you reside in Denver, visit the Denver Holistic Center for more information and help reduce the distress associated with menstrual migraines. Conclusively, for all women experiencing symptoms of migraines during their menstrual cycle, they should consult with their physician if over the counter medication is not adequate.


Figure 1 – This was a study performed which shows the treatment plan for menstrual migraines.

Figure 1 – This was a study performed which shows the treatment plan for menstrual migraines.

Management strategies for menstrual migraine. CHC, combined hormonal contraceptives; GnRH, gonadotrophin-releasing hormone analogue; HFI, hormone free interval; HRT, hormone replacement therapy; lUS, intrauterine system; NSAIDs, nonsteroidal anti-inflammatory drugs; Rx, treatment. Reproduced with permission from MacGregor, E.A. (2007) Menstrual migraine: a clinical review, J Fam Piann Reprod Health Care 33: 36–47.