Menstrual migraines and menstrual headaches can be a real pain, literally. They are menstrual-related symptoms brought about by the changes in hormone levels throughout the menstrual cycle, commonly experienced just before or during menstruation. In this post, we go head first into what menstrual headaches and migraines are, the different types, why they are caused and what you can do to help them and hopefully prevent them.

DISCLAIMER: THIS BLOG POST DOES NOT PROVIDE MEDICAL ADVICE

The information in this blog post, including but not limited to the text, graphics and images, are for educational and informational purposes only. None of the material within this blog post is intended to substitute medical advice, diagnosis or treatment. Always seek the advice of a qualified medical professional such as your doctor when you have concerns or questions.

Woman sat cross-legged on a chair with her hands over her ears, looking like she is in pain.

Menstrual Migraines and Menstrual Headaches: what are they?

Menstrual migraines and menstrual headaches are broadly defined as headaches that coincide with the menstrual cycle either just before or during menstruation and can happen every month, with every cycle.

Migraines

Migraines are considered more severe than “headaches”. They are a neurological condition involving symptoms such as severe pulsing in the head or a dull throbbing, nausea, dizziness, fatigue and light sensitivity. These symptoms can last for just a short time like a few hours, up to several days and can get worse with light, smells, sound or movement.

Headaches

Headaches are more commonly experienced than migraines and are notably less severe. Headaches are essentially a pain or pressure in the head or face that is constant, sharp, dull or throbs. There are over 150 types of headaches, but the most common type is the tension headache, which falls within the primary headache category. Primary headaches are those which are not caused by an underlying condition and are a result of over-activity of pain-sensitive features, or dysfunction of these. Migraines are also categorised as a primary headache when they are not a result of an underlying condition. However, some factors can trigger primary headaches, such as sleep changes, alcohol and poor posture. On the other hand, secondary headaches are those which are caused by an underlying medical condition and are generally seen as just a symptom of another issue, such as dehydration, or a head injury.

Migraines and headaches and the menstrual cycle: how are they connected?

Women and those with a uterus reportedly experience migraine attacks three times more frequently than those without a uterus, and 60-70% have stated a connection between these attacks and their menstrual cycle. Headaches (or migraines) that are associated with the menstrual cycle are termed menstrual-related headaches (MRH).

Menstrual-related headaches (MRH)

Menstrual migraines (MM) have been recognised as a specific type of migraine that occurs around the time of menstruation, generally within a day or 2 after the onset of a period, but also just before, during the late luteal phase of the menstrual cycle. These are triggered by the decline in estrogen levels at this time of the menstrual cycle, mainly due to its effect on serotonin levels, a neurotransmitter involved in mood regulation in addition to a lot of other bodily functions.

What causes menstrual-related headaches?

Both estrogen and serotonin levels have been directly linked with headaches. During the late luteal phase, estrogen levels are low which in turn decreases the amount of serotonin. The decrease in both of these is the reason for several premenstrual syndrome (PMS) symptoms, in which headaches are a common one. Low serotonin levels, leads to an increase in other substances that are directly involved in the pathophysiology of general migraines. These substances then act on the pain pathways, making pain in the brain feel more intense (Charles & Brennan 2010; Frederiksen et al. 2020).

Woman with a lot of reckles on her face with her eyes closed and her right hand over her forehead.

Who gets menstrual-related headaches?

Well, those that do menstruate for one. It is said that 41% of those with a uterus will have experienced a migraine at least once prior to the onset of menopause (Burch 2020). There are other risk factors though. One of them is taking certain hormonal medications, such as the hormonal combined contraceptive pill where higher estrogen doses are provided, where the decrease during the late luteal and early follicular phases of the menstrual cycle could have more of an impact, causing MRH.

What does a menstrual-related headache feel like?

MRH’s generally feel the same way as those headaches not associated with the menstrual cycle. The only difference is, that a MRH occurs within the two days before the period begins, and the third day of menstruation (with no other notable trigger).

Diagnosing menstrual-related headaches

The third edition of the International Classification of Headache Disorders (yep, that’s a real thing) has recognised menstrual migraines as an official type of headache. There are two types that present themselves in different ways and are diagnosed as follows:

1) Menstrual-related migraine

migraine attack without aura (a sensory disturbance that acts as a warning stage)

occurs within the late luteal or early follicular phase of the menstrual cycle (two days before menstruation begins, until day 3 of menstruation)
occurs in 2/3 menstrual cycles
but migraine attacks are also experienced outside of the above time frame

2) Pure menstrual migraine

migraine attack without aura (a sensory disturbance that acts as a warning stage)
occurs within the late luteal or early follicular phase of the menstrual cycle (two days before menstruation begins, until day 3 of menstruation)
occurs in 2/3 menstrual cycles
migraine attacks are NOT experienced outside of the above time frame (only associated with menstruation)

Notice that these types are both migraines; associated with throbbing head pain, sensitivity to light and sound and nausea. Although not officially classified, other less severe primary headaches have been shown to be associated with menstruation and the menstrual cycle. A recent publication by Ruiz-Franco et al. (2023) showed data from a study which confirms the existence of pure menstrual tension-type headaches. The reported frequency of these is less than that for menstrual migraines, and of course, they are not as debilitating as migraines, which explains why they have yet to be recognised and officially classified.

The best way to diagnose a menstrual-related headache or migraine is to basically make a note of when they occur, in relation to your menstrual cycle. A period-tracking App with symptom tracking is a good tool for this. That way, if you do notice a pattern, then you can also mention this to your healthcare provider when you seek medical help.

Why does it matter if headaches are associated with the menstrual cycle or not?

Headaches or migraines that are associated with particular phases of the menstrual cycle are likely brought about by hormonal fluctuations, meaning that the underlying cause could be hormone-related and therefore treatment and preventative measures involving hormonal therapy are one of the options that can be considered.

How to treat or prevent menstrual-related headaches and migraines?

If you are experiencing regular headaches or migraines, related to your menstrual cycle or not, it is best to speak to a healthcare provider about it and figure out what could be the underlying cause and what treatment options there are for you.

Some treatment options involve hormonal therapy, either changing the hormone regimen currently being taken when hormonal contraceptive methods are being used or starting hormonal therapy. In doing this, the estrogen dose is usually reduced to prevent such a dramatic decline during the luteal phase. However, this approach is usually only beneficial with those who have a regular menstrual cycle (Brandes 2006).

lying down on a sofa with head propped up on pillows, with her left hand over her forehead and her eyes closed. On a table next to her, is a glass of water and some pills.

Of course, not everyone is willing or able to consider hormonal therapy. Some nonsteroidal anti-inflammatory drugs (NSAIDs) have been studied concerning treating menstrual-related headaches (MacGregor 2010). Taking Ibuprofen can be considered a first-line intervention for a headache, for example, but taking this regularly and for extended periods is not recommended, so it is best to speak to your doctor if you are dealing with persistent or cyclical headaches or migraines.

There are some other options involving medication that actively blocks the pathophysiological aspects of migraines on a molecular level, such as triptans which are serotonin receptor agonists and act by promoting vasoconstriction (Tabeeva et al. 2019).

In contrast to medication, some therapeutic lifestyle measures can be considered for managing and potentially preventing migraines and headaches, whether related to the menstrual cycle or not. Such measures include ensuring proper sleep hygiene, nutrition and regular exercise. Reducing alcohol intake and stress levels can also be beneficial, as well as avoiding weather conditions that may trigger migraines. The key here really comes down to identifying the factors that trigger your migraines and headaches and then avoiding these; if possible.

Conclusion

The important thing to remember is that if you are affected by migraines or headaches, regularly, whether that be connected with your menstruation or not, it is just best to speak to a medical professional. Menstrual-related headaches are not a symptom that should be ignored, or even just tolerated.