What Is a Menstrual Migraine?

Day one of your period, and the lights are too bright. A throb sets up behind one eye and settles in. You close the blinds, lie down with a washcloth on your face and think, again, that it’s always this week. You’ve never written it down, so you don’t know if you’re right.

Why it happens

The Migraine Trust² says a drop in estrogen is a common trigger, and that prostaglandins, which rise around period time, have also been linked to migraine. Our article on diarrhea on your period covers prostaglandins in the gut.

The NHS³ describes a migraine as a throbbing headache, often severe and often on one side, with nausea and light sensitivity, lasting from 4 hours to 3 days, and says migraine attacks that happen right before or during your period are called menstrual migraines. Other triggers it lists include stress, tiredness, skipped meals, too much caffeine, anxiety and depression.

How it’s confirmed

There’s no test. The Migraine Trust² says to keep a diary for at least three months, recording both your attacks and your periods, which helps show a clear pattern. The American Migraine Foundation¹ says the same: keep a headache and cycle diary if you think your attacks are related to your cycle, noting the timing and specific symptoms.

What treatment looks like

For an attack. The NHS³ lists painkillers like ibuprofen and paracetamol, triptans, gepants and anti-nausea medicines, and says to take them as soon as your headache starts. It says to try not to use painkillers more than 2 days a week, because of medication-overuse headaches. See waking up with a headache.

For prevention around your period. The American Migraine Foundation¹ lists mini-prevention, taking an NSAID, a triptan or estrogen in the days leading up to a period. The Migraine Trust² says a triptan called frovatriptan is commonly used this way, taken around the expected window.

Hormonal approaches. The American Migraine Foundation¹ says a continuous dose of birth control can prevent estrogen swings entirely, but that estrogen’s effect is unpredictable: it may decrease migraine frequency, trigger attacks or do nothing at all. The Migraine Trust² says you can’t take combined hormonal contraception if you have migraine with aura, and that continuous pill use without breaks may help by avoiding the sharp drop in estrogen. Both point to individual medical advice.

The NHS³ also lists prevention medicines such as beta blockers, antidepressants and epilepsy medicines, plus acupuncture, relaxation and vitamin B2.

The play

Try this: a headache and cycle diary

For at least three months, mark the first day of each period on a calendar, and write down each headache’s start time, strength from 1 to 10, other symptoms (nausea, light sensitivity, aura), what you took and whether it worked.

At the end of three months, count how many attacks fall in the window two days before to three days into your period.

Bring the diary to your clinician and ask about mini-prevention.

When to get checked

Don’t wait if

1. Emergency

   The NHS³ says to see a GP if attacks are getting worse, happen more than once a week or are hard to control, and mentions menstrual migraines specifically. It says to call emergency services for a sudden extreme headache, loss of vision, speech problems, confusion, weakness on one side of the body, high fever with meningitis symptoms or a recent head injury.

2. Emergency

   Get emergency care for the signs above.

Book an appointment if any of these fit:

• Migraines show up around your period most months
• Painkillers aren’t controlling them, or you use them more than 2 days a week
• Attacks are getting worse or more frequent
• You have aura and use, or want to use, estrogen-containing birth control
• Your attacks keep you from work, school or caring for others

If it’s always that week, the diary is how you prove it, and proof is what unlocks treatment.