Unfortunately, many women have resigned to menstrual migraine (also known as hormonal migraine) because they believe if there’s little you can do about your cycle then there is not much you can do about your migraine attacks. Right?
Wrong!
There a number of options to treat and prevent, yes, prevent menstrual migraine attacks. To understand how and why these treatments can help, it is important to understand what happens and how things change during the month.
Contents
How The Menstrual Cycle Can Cause Migraine
Women who experience menstrual migraine may be sensitive to hormonal fluctuations experienced just prior to the onset of menstruation. Just before menstruation there is a natural drop in progesterone levels.
The two important females hormones involved are progesterone and estrogen.
Progesterone is a natural steroid hormone involved in the female menstrual cycle that stimulates the uterus to prepare for pregnancy. It is a naturally occurring hormone in the female body that helps a healthy female function normally.
Estrogens or oestrogens (American and British English spelling respectively), are a group of compounds that are important in the menstrual and reproductive cycles. They are also naturally occurring steroid hormones in women that promote the development and maintenance of female features of the body.
It is important to note that estrogens are used as part of some oral contraceptives and in estrogen replacement therapy for some postmenopausal women.
Throughout the natural menstrual cycle the levels of these hormones fluctuate. During the cycle, the levels of progesterone and estrogens also change in relation to each other. See the image below for how these levels change throughout the cycle.
These fluctuations are normal and part of being a healthy and fertile woman.
Several research studies confirm that migraine is significantly more likely to occur in association with falling estrogen in the late luteal/early follicular phase of the menstrual cycle. [8]
Researchers failed to find an absolute level of estrogen associated with migraine in this phase which supports the theory that falling levels of estrogen are more important than an absolute level. [8,9]
The withdrawal of estrogen is independent of several important factors [9]:
- It is independent of ovulation as it can trigger migraine during the hormone-free interval of combined hormonal contraceptives.
- It is independent of menstruation and progestin as migraine can be triggered in those who have had hysterectomies.
Interestingly, no clear relationship between progesterone and migraine was found. [8]
Is estrogen withdrawal the sole trigger for menstrual migraine?
Researchers suggest no. Menstrual migraine is associated is menstrual cramps and painful periods, both of which respond to nonsteroidal anti-inflammatory drugs. This suggests the involvement of prostaglandins. Prostaglandins are hormones created at the site of injury or illness. They help control inflammation, blood flow, and the formation of blood clots.
Prostaglandins levels have been shown to increase threefold during the luteal phase of the menstrual cycle with a further increase during the first 48 hours of menstruation. This mirrors the timing of an increased risk of a migraine attack. [9]
Timing Is Important
Across the menstrual cycle menses typically occurs from day 1 to day 5. This is where up to 40% of women reported a migraine attack. In the three days prior to day one, the incidence of migraine in women rises by approximately 10% to 25%. [8]
The timing of a menstrual migraine attack provides clues on how best to treat each case. Below are different hormonal states that may be causing regular menstrual migraine.
- If it occurs just prior to the onset of menstruation then it may be due to the natural drop in progesterone levels.
- Headaches or migraine can also occur at ovulation when estrogen and other hormones peak.
- Or it may occur during menstruation itself when estrogen and progesterone are at their lowest.
Knowing when your menstrual migraine occurs will determine the best prevention strategy.
A good way to determine when your migraine attacks are occurring is by keeping a record of at least 3 cycles to track exactly when your migraine attacks occurred. Remember to note the precise day(s) of your cycle as closely as possible.
Once you have a clear understanding of which days in your menstrual cycle the migraine is occurring, then you are in a better position to begin treating it. A simple diary can be very helpful.
Diagnosis
Menstruation increases the likelihood of migraine without aura, but not for migraine with aura. [9]
Most women with migraine associated with menstruation also have additional attacks with or without aura at other times of the cycle. [9] The diagnosis for this type of migraine is referred to as Menstrually-Related Migraine.
Fewer than 10% of women report migraine exclusively with menstruation and at no other time in the month. The formal diagnosis for this minority of female patients is Pure Menstrual Migraine. [9]
In those who have Menstrually-Related Migraine, attacks that occur during menses are likely to be more severe, disabling, last longer, and be less responsive to medications compared to attacks at other times of the cycle. [9]
Interestingly, migraine with aura appears to be unaffected by menopause whilst migraine without aura can be exacerbated by menopause. [9]
To diagnose menstrual migraine a history, examination, and diary analysis is required by your healthcare professional. There should only be investigations or further tests required to rule out any other primary causes of migraine.
Relying solely on memory is considered insufficient and a diary over at least two to three consecutive menstrual cycles is considered best practice. [9]
International Classification of Headache Disorders (ICHD) III
A1.1.1 Pure menstrual migraine without aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.1 Migraine without aura and criterion B below
B. Occurring exclusively on day 1 ± 2 (i.e. days −2 to + 3) of menstruation in at least two out of three menstrual cycles and at no other times of the cycle
A1.1.2 Menstrually related migraine without aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.1 Migraine without aura and criterion B below
B. Occurring on day 1 ± 2 (i.e. days −2 to + 3) of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle
A1.2.0.1 Pure menstrual migraine with aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.2 Migraine with aura and criterion B below
B. Occurring exclusively on day 1 ± 2 (i.e. days −2 to + 3) of menstruation in at least two out of three menstrual cycles and at no other times of the cycle
A1.2.0.2 Menstrually related migraine with aura
A. Attacks, in a menstruating woman, fulfilling criteria for 1.2 Migraine with aura and criterion B below
B. Occurring on day 1 ± 2 (i.e. days −2 to + 3) of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle
Menstrual Migraine Management
The most effective strategy to manage menstrual migraine depends on several factors [9]:
- How well acute treatments work for the patient
- Predictability and regularity of the menstrual cycle
- Use of or need for contraception
- The presence of menstural disorders or perimenopausal symptoms
Acute Treatment
Treatments indicated for acute migraine can be used to treat menstrual migraine. [9] Most treatments have not been tested specifically for menstrual migraine attacks so the true efficacy of some of these treatments in menstrual attacks is unclear.
Table: Acute Treatment of Menstrual Attacks of Migraine [9]
If used only around the time of menses then the risk of developing medication overuse headaches is low. Due to the long duration of menstrual attacks, repeated relapse can be an issue and a need for prevention is may be required.
Prevention
Those who have frequent migraine throughout their cycle regardless of the relationship to menstruation are likely to benefit from prevention strategies.
If preventive treatment reduces the frequency and severity of nonmenstrual attacks but not menstrual attacks, then a “mini” perimenstrual preventive strategy is indicated.
Perimenstrual Prevention
The prefix “peri” refers to prevention around menstruation. These are short term treatments which target the time of increased risk during the cycle. This differs from standard preventive strategies which continue on an ongoing basis across the full cycle.
Important: For perimenstrual prevention the use of the treatment is different from the label so the drug will likely need to be prescribed off-label. Always seek medical advice and supervision if considering perimenstrual prevention.
The best evidence supports the use of Frovatriptan. This is given the highest level rating as “A” for its efficacy evidence. Frovatripan can be taken at 5 mg twice daily starting two days before day 1 of the cycle, then 2.5 mg for five days from day one of the cycle (total of six days). [7,9]
Naproxen has a “B” level rating but it still the next best option to try if Frovatriptan has negative side effects or is contraindicated for any reason. 500 mg of naproxen is taken daily for 14 to seven days over the high-risk window during the cycle. This treatment can commence one week prior and continue until one week after day one of the cycle. [9]
Level B evidence also supports the consideration of naratriptan and zolmitriptan.[9] Naratriptan 1 mg, two times a day is taken for six days, starting three days before the expected onset of menstrual migraine. Zolmitriptan 2.5 mg is taken two-three times a day for seven days starting two days before the expected onset. [9]
Estradiol gel, an estrogen supplement, has a “C” level rating but is also another option. 1.5 mg daily is used for seven days. This treatment regime commences five days before the onset of menstruation and continues until day two. This strategy prevents the late luteal phase drop in estrogen that can trigger estrogen withdrawal migraine. Important note: women using should be menstruating regularly with natural progesterone following ovulation providing endometrial protection. [9]
Prevention (Prophylaxis)
Continuous hormonal options aim to suppress ovarian activity and maintain hormonal levels.
Contraceptives
For women who also need contraception, there are several contraceptive strategies that may also benefit migraine. For migraine with aura, combined hormonal contraceptives have additional benefits including a reduced risk of endometrial and ovarian cancer. [9]
Estrogen withdrawal during the hormone-free interval can trigger migraine attacks but can prevented using estrogen supplements. Estrogen supplements that may be considered include [9]:
- 10 mcg of oral ethinyl estradiol
- 0.9 mg oral conjugated equine estrogens
- 100 mcg estradiol patches
- 2 g estradiol gel
A simpler way to reduce the number of withdrawal bleeds and number of attacks may be to use an extended cycle of 84/7 regimes or to none through continuous combined hormonal contraceptive use. [9]
Continuous combined hormonal contraceptive use are well tolerated. Unscheduled bleeding is common in the early cycles of treatment but usually resolves over time. Typically by 10-12 months 80-100% of women experience no bleeding.
Some evidence suggests that if menses is avoided consistently then that can benefit the migraine condition. [9]
Side Effects
Combined hormonal contraceptives are associated with an increase in stroke by twofold. This risk should not be a significant concern for patients with no other cardiovascular risk factors. Patients should be screened for these risk factors before prescription.
Common cardiovascular risk factors:
- High blood pressure
- Obesity
- Smoking
- High Cholesterol
- Diabetes
- Family history of cardiovascular event
- Migraine with aura
- Poor diet
- Lack of physical activity
The presence of migraine with aura is associated with a twofold increase in stroke. Therefore patients with migraine with aura are not advised to add further risk by taking combined hormonal contraceptives. [9]
Gonadotrophin-releasing hormone analogues
This treatment has been found useful in resistant menstrual migraine conditions for some patients. It causes a reversible ‘medical’ menopause resulting in the cessation of ovarian activity. Add-back hormone replacement therapy is usually required to treat any unwanted side effects and preserve bone density. [9]
Surgery
A hysterectomy with or without the removal of one or both ovaries increases the risk of migraine. [9] Therefore surgery is not recommended for menstrual migraine.
If a hysterectomy is indicated for other gynecologic factors then the effect on migraine can be managed with the immediate use of continuous transdermal estrogen replacement therapy. [9]
Therefore to answer the question: Should you get a hysterectomy for menstrual migraine? The answer is a definitive no.
A hysterectomy purely for menstrual migraine is permanent, invasive and an expensive surgical operation that has been shown to make migraine worse. [9]
Why is it ineffective for menstrual migraine?
Menstrual migraine attacks are caused by a fall in hormones which are triggered by the ovaries. Whilst menstruation stops with a hysterectomy, it does not stop the ovaries from continuing to produce monthly hormonal fluctuations which can trigger migraine.
There are other ways to non-surgically address the hormonal fluctuations caused by the ovaries. See hormonal treatments listed above.
Complementary Menstrual Migraine Treatments
There are many different approaches to help manage menstrual migraine some involve medicinal treatments and others do not. Often it may involve a combination.
Rest assure that it is possible to reduce and in some cases eliminate menstrual migraine. But it may involve working with a specialist and some trial and error.
Complementary approaches for those with menstrual migraine include:
- Dietary changes
- Lifestyle factors
- Hormonal balancing
- Magnesium
- Other natural therapies
Most women with menstrual migraine have a healthy hormonal balance. However, if there is an imbalance of estrogen in relation to progesterone then a healthy diet is the first step (in fact it should be one of the first steps for migraine patients). What we eat plays a huge role in our overall health and wellbeing.
“Nothing else affects our health more than what we eat.”
If you experience migraine attacks then your diet can be important.
We hear all the time from the health community something like ‘eat a varied and well-balanced diet to help prevent disease’. It’s been said so many times we can become numb to this important advice.
To complicate things, some healthy foods may also act as triggers. Finding out which foods trigger attacks is not always easy.
Dietary Changes
Why Might Diet Important For Menstrual Migraine?
Estrogen levels require stricter regulation compared to other hormones in your body to ensure the natural rhythm runs smoothly (2). If this balance is slightly off for what your body requires, then you may experience discomfort with symptoms such as PMS, breast tenderness, headaches and, in susceptible women, migraine attacks.
Small variances above or below the normal regulated levels can have significant impacts on your health.
The liver metabolizes estrogen. A healthy liver will rapidly metabolize estrogen but if it is overloaded with medications, artificial substances, chemicals or harmful substances from food or drinks can affect the metabolization of estrogen.
Our diet is thought to be the biggest factor affecting our hormones through the exposure to certain chemicals in food products. Research suggests that diet can attribute up to 90% of all factors affecting your hormones (3).
“Compared to other hormones such as progesterone, estrogen levels need to be tightly regulated for the ‘choreography’ to run as smoothly as Mother Nature intended — even small excesses or deficiencies of estrogen can have huge effects on your well-being. A healthy liver metabolizes estrogen rapidly into the more benign of its metabolites. But when it’s bogged down with detoxing medications, environmental chemicals, and harmful substances from food or drink, it can over-metabolize estrogen into its less desirable forms, which can pose a real threat to your health if allowed to accumulate.”
Certain food ingredients act like toxins which can disrupt your hormonal balance, so reducing or eliminating these help keep your hormones in balance. Examples of toxins you may commonly come across include:
- MSG (monosodium glutamate) – found as a flavor enhancer in many processed foods.
- Hydrolysed Vegetable Protein
- Aspartame
Avoid or, if possible, eliminate
- simple carbohydrates
- refined sugars
- processed foods
- avoid well-known migraine trigger foods.
If in doubt about what food triggers your attacks, it may be worth considering some of the following:
- keep a food diary
- food allergy test
- detoxification
- an elimination diet or migraine friendly diet
- consult a certified dietitian or nutritionist
Keeping a food diary is highly recommended. Be careful to include in your diary not just what you eat, but also record other factors which may affect your migraine attacks to minimize misattribution of a migraine attack to a particular food or trigger. Uncovering what exactly caused the attack takes a some time and patience but the process gives you more control and confidence over your condition. The results are often surprising.
Food allergy tests unfortunately do not test for specific migraine triggers. But they can be effective at showing what foods your body is reacting abnormally too. Eliminating foods which cause stress or overreactions in the body may improve your migraine frequency or severity.
A detoxification may help cleanse your system of the offending substances but there is little scientific evidence supporting the efficacy of a detoxification. It may simply be a psychological way to push the ‘restart’ button when beginning a new eating regime.
If you are serious, consulting a certified health care professional like a nutritionist or dietitian to assist you is a good idea. Elimination diets can be tricky and sometimes dangerous to do by yourself. There is a risk of malnutrition if you don’t know exactly what you’re doing.
To ensure your wellbeing seek qualified professional support. That way you will have the best chance of reducing your attacks without malnourishment or starvation.
Another simple dietary preventive strategy is simply a matter of drinking enough water, especially during menses. Herbal teas are also great option for hydration if you’re getting bored with water. In summer a slice of lemon or lime with mint and water can also be a refreshing way to stay hydrated.
Lifestyle Factors
Lifestyle factors like sleep, movement or exercise play a central role in migraine management.
The right levels of sleep and exercise are vital for brain health. What is good for the brain is good for migraine.
Sleep is a restorative function for brain and body. It is not just about getting enough sleep each night. It’s about how regular your sleep/wake cycle is. Are you going to bed and waking up at the same time each night? What about on weekends?
It’s also about the quality of sleep. The hours of sleep before midnight count more. 9 hours total sleep starting from 10pm is much better than 10 hours of sleep starting from 1am.
Are you waking up at the same time each morning?
Nobody is perfect, but the better you can get into a consistent routine of high-quality sleep, the better for your condition.
Exercise promotes a healthy metabolism, hormonal balance, reduces stress, assists in sleep, stabilizes your mood and gives you an overall sense of well-being.
Just in case you needed another reason to exercise, the brain loves movment and exercise. Exercise is a great preventive strategy for many with migraine and the science proves it. One study showed [5] that exercising using the indoor bike for a 20 minute workout three times per week was as effective as one of the most popular migraine preventatives – topiramate.
For a few people exercise can trigger migraine attacks. If that’s the case, start slowly and build gradually. Give yourself a generous and slow warm-up before jumping into your exercise. Be sensible about it. Don’t start by trying to run 5 miles. Don’t exercise on days when your feeling vulnerable to a migraine attack.
If you exercise outside, wear a hat, keep hydrated, and don’t let yourself get too hungry.
The evidence for daily exercise is still being uncovered. Even starting small with a five-minute walk or a short, easy bike ride can be beneficial. Aim for 30 minutes of some activity or movement each day. You can break it up, for example into three 10 minute sessions.
You will feel better for it. When you take care of your body, your body is more likely to take care of you.
Hormone Balancing
Addressing hormones without addressing underlying diet and lifestyle factors is like trying to clean the house by sweeping all the dirt under the rug. It’s a superficial approach.
Hormones do have a significant influence on bodily functions. 80% of pregnant women experience a remission of migraine during pregnancy according to studies. [6]
To assess hormone levels, blood, saliva, and urine testing may be performed to establish a baseline and to identify any hormonal imbalances which may be contributing to migraine.
Thyroid testing is also important as hypothyroidism is more common in those with migraine.
In menstrual migraine, often the trigger is the falling levels of estrogen which occurs naturally before menses. Estrogen can be topped up in several ways such as via skin patches or gel which is absorbed into the bloodstream. A patch can be applied for seven days beginning three days prior to the first day of menses. Note: if you are trying to get pregnant you should speak to your physician before you explore hormonal treatments.
Another increasingly popular approach to deal with the drop of estrogen involves stabilizing hormones through the use of the low dose estrogen combination pill which has a constant dose (monophasic).
For others with menstrual migraine, problems may appear to arise due to the estrogen dominance and progesterone deficiency. In these cases, bio-identical progesterone in the second half of the female cycle to balance the hormones has shown some success (4).
It is a good idea to consult with a healthcare professional who has experience with menstrual migraine and who understands female hormones. Look for a headache specialist, certified gynecologist or endocrinologist who has a good track record with menstrual migraine.
Magnesium
Dr. Mauskop from the New York Headache Center has found that magnesium supplementation for those with menstrual migraine may be beneficial. He has also found that low magnesium levels may be attributed to a lower migraine threshold. Lower migraine thresholds make you more vulnerable to attacks and require less stimulation and fewer triggers to lead to an attack.
400 mg of magnesium every day can be used as a migraine preventative. Unfortunately there no simple tests for magnesium deficiency as it’s the intracellular level of magnesium that we need to improve. The best way to see if it works for you is to try it and ensure that you are absorbing it effectively.
If the migraine attacks are severe or also occur frequently outside of menses then a migraine preventative may be prescribed.
When considering preventive medicinal treatments it is best to discuss what options might be best for you with your doctor who has your full medical history.
Other Natural Therapies
There is less clinical evidence behind the efficacy of natural and homeopathic therapies, but they may have fewer side effects, be better tolerated and offer a natural alternative.
That said, if they don’t help, you’ve wasted your money.
Do your research before jumping into these kinds of treatments to decide if it’s appropriate. Discover 6 natural, complementary treatments with evidence for migraine.
If you don’t have a well-balanced diet then you may not be getting your required vitamins and minerals. Supplements in this scenario may be useful. Some that have been reported to help those with migraine include Riboflavin, Feverfew, Butterbur, Vitamin B6, Magnesium, Ginger, Coenzyme Q10 (CoQ10) amongst others.
Ordering the cheapest option from Amazon is not your best option. Vitamins are still considered medication but have far less regulation and quality controls in place. Often it’s worth paying extra for a reputable brand to ensure quality and safety.
Many vitamins are contraindicated for pregnant women or women trying to get pregnant so speak to your pharmacist or doctor before ordering them.
Perimenopause
Perimenopause increases the risk of migraine and additional complications around irregular periods which can make perimenstrual prevention difficult. Perimenopausal symptoms may also warrant specific treatment often with hormonal replacement therapy. [9]
Oral estrogen can make migraine worse so non-oral routes are preferred and administered continuously to stabilize hormone levels. [9]
Endometrial protection with progestin is needed for many women in perimenopause and continuous delivery again is better tolerated than cyclical administration. [9] Levonorgestrel intrauterine system currently licenses continuous progestin treatment which is available to perimenopausal women.
If estrogen is not an approved option for any reason then paroxetine 7.5 mg at bedtime is the only non-hormonal therapy approved by the FDA for the treatment of perimenopausal symptoms. Gabapentin has grade “A” evidence to help with symptoms from perimenopause but there is currently inadequate or conflicting data to support or refute this treatment for migraine (Grade “U”).
Summary
To summarize, if your migraine attacks occur at the same time each month:
- Keep a diary to inform you and your healthcare professional of exactly when the attacks begin during your cycle.
- Take into account how predictable and regular your cycle is.
- Evaluate the need for contraception
- Is there a presence of menstrual disorder or perimenopausal symptoms?
- Consider daily prevention or perimenstrual prevention
- Review your diet
- Get enough quality sleep, consistently
- Exercise regularly
- Stay adequately hydrated, especially during menses
- Try magnesium supplementation
- Balance your hormones
- Consider other natural alternatives or supplements known to help those with migraine.
Often, it is the things we consume or do unknowingly that exacerbate migraine. Identifying and modifying these factors with an improvement to your lifestyle and diet is where you can have the most dramatic and sustainable results.
Still have a question for relating to menstrual migraine? Ask in the in the comments below.
Prevent hormonal or menstrually related migraine attacks with the help of this simple one-page checklist. For a limited time, we are emailing a copy to every reader.
Article References
- MacGregor E.A., Brandes J., Eikermann A., Giammarco R. (2004) Impact of migraine on patients and their families: the migraine and zolmitriptan evaluation (MAZE) survey-phase III. Curr Med Res Opin 20: 1143–1150
- Holmes, M NP, http://www.womenshealthnetwork.com/womenshealth/menstrualmigraines.aspx Accessed Oct 2013.
- Fürst P (October 2006). “Dioxins, polychlorinated biphenyls and other organohalogen compounds in human milk. Levels, correlations, trends and exposure through breastfeeding”. Mol Nutr Food Res 50 (10): 922–33.
- Mostovoy, A. ‘Migraines – Helpful Solutions’ http://www.drmostovoy.com/Migraines.html. Accessed Oct 15, 2013
- Varkey, Emma, et al. “Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls.” Cephalalgia 31.14 (2011): 1428-1438.
- Somerville, Brian W. “The role of estradiol withdrawal in the etiology of menstrual migraine.” Neurology 22.4 (1972): 355-355.
- MacGregor, A. ‘Hormonal Influences In Migraine’. Presented at ANZHS Masterclass. 18 August 2018.
- MacGregor, E. A., et al. “Incidence of migraine relative to menstrual cycle phases of rising and falling estrogen.” Neurology 67.12 (2006): 2154-2158.
- MacGregor, E. Anne. “Migraine management during menstruation and menopause.” Continuum: Lifelong Learning in Neurology 21.4, Headache (2015): 990-1003.
Thank you for this guide. It is very helpful, the problem however is finding a healthcare provider who will work with you regarding the steps for hormones. I had a hard time just getting a provider to order hormone levels. Ob/Gyn said its primary Doctor, primary Doctor said Ob/Gyn. Vicious circle. No one will do the saliva testing. This summit has been great, but on the downside it’s hard to find a doctor who will listen. I also have a question, whether deorderants can play a role with hormones?
Finding a doctor is difficult but not impossible. You may need to call around and get advice from support groups which are becoming increasingly useful for example on Facebook. re: deodorants, there has been concerns raised over the parabens and aluminium content. If hormones are a factor then it’s a good idea to use paraben-free & aluminium-free deodorants.
Yes I agree hormone doctors hard to find and the good ones are cash only no insurance!
It is very hard to find a doctor who will help with balancing hormones. I have had more than one doctor tell me, "It’s complicated". However, I have found a great resource in Dr. Lara Briden, who has a blog and a book on women’s health. I started taking DIM and evening primrose oil, and while that helped with some PMS symptoms, they didn’t tough my hormonal migraines. Following Dr. Briden’s advice and also because I did some genetic testing, I started B6 as p-5-p and calcium d-glucarate. Those have pretty much eliminated my hormonal migraines. She also has dietary advice to help also. BTW, I also take B2, magnesium ( magnesium threonate) and avoid dietary triggers such as excess glutamate.
It is complicated. But that’s fantastic news Sara. You are a great example of how each of us are unique and that there are no silver bullets. It requires an educated effort from us, in partnership with the right healthcare professional to see lasting and significant results. Congrats!
Super curious about the supplements you mentioned and if you’re still clear of hormonal migraines? What’s p-5-p?
I had it under control for over three years when I was on Depo Prevera for my endometriosis. I was actually on it too long and was suffering from a lack of estrogen and my idiot (you just had to be there for the whole story… not everything belongs here, heh) OB-GYN gave my an estrogen pill that was supposed to stop the endometriosis AND STOP my periods. Well, I’m not SURE about the endo though I’m cramping like heck, but this last month and a half has been nearly on solid period and nearly one solid migraine. 4-5 to a week and one 8 day long one. I was in the ER once and nearly a second time. We’re waiting on getting into another OB-GYN right now… the request for a referral has been made through my PCP. Saw my neurologist Monday and she said in my case I need a birth control that will stop all menses completely. Does this sound right from the migraine point-of-view? I don’t ever want to have children so child-bearing is not a concern in my book. I have too many genetic disorders that I don’t want to pass on, and I don’t know how I could go off my medications for 9 months and bear the pain from all of them when I should be happy and glowing. Any husband of mine will have to settle on adoption or he’s not worth his salt. So I plan to stay period free the rest of my life if I can help it. Do you have any suggestions in this realm?
Cassie
I’ve heard of cases where you can take medicinal hormonal interventions to remove your cycle altogether for periods of a year or so. But you’ll need to speak to your healthcare professional about the risks of this approach over the long term.
The decision for children is a very personal one. The risk your child inherits your conditions may be well below 50% if your husband doesn’t experience them. For me, I’ve had chronic migraine… even if I knew my child was 100% guaranteed migraine. I’d still have one. Is that cruel? Some could argue yes. But if someone gave me the choice in advance to exist or not, I know what I’d say 🙂
I’d encourage you to make that decision not on the risk your child might inherit something, but on whether it’s something you really want or not.
Hi Cassie! I’ve had menstrual migraines for years now. Three months ago I decided to stop using tampons – instead I use those period panties that you can buy online (they’re amazing!). I had been using OB super duper plus size tampons and wearing them for about 8 hours at a time. Since switching to no tampons I have not had a single menstrual migraine, not one! I honestly think I was putting my body into a mild state of toxic shock every time. My migraines would always start off with this weird toxic feeling in my belly and then I knew I had to get somewhere cold and dark and quiet. Might be worth thinking about if you don’t want to stay on hormones meds your whole life and would like to be migraine free. This article above talks about what kinds of food we put in our mouths, I think that should be extended to what we put in our bodies, food or otherwise. There is a lot online about how bad tampons can be for you. I hope this different perspective helps!
Very interesting Kim. It is possible that chemicals we apply on our body included in deodorants, makeup, body lotions, sun cream etc. can be absorbed into the body. I never thought of tampons or pads also playing a role in this but your experience is eye opening.
Thank you for sharing Kim!
COMMENTI’m just curious how you came to the decision about the tampons and what made you think they were related to the migraines?
Hi Cassie, I have suffered severe aura migraines since I was 12 years old. I have had 4 children and none of them suffer with migraines. I would also like to share with you that my migraines stop completely throughout the nine months of pregnancy., it was bliss. So please don’t let migraines deter you from having kids, in my experience it was a help not a hinderence.
Brilliant article. Thank you. Most of these things I do already but there are a couple I haven’t tried. Thank you.
Thanks Gemma, glad you liked it. Hopefully there are a few more ideas here to discuss with your healthcare professional.
I am a 69 year old woman and have had migraine since around the age of 12. I seemed to have had hormonal type migraine as they started just prior to a period and carried on through the period and also occurred mid month which I assumed was my fertile period. I had always been told by doctors they would probably disappear post menopause but they haven’t and even seemed to become more frequent. Since picking up some tips from your guide, I feel the things I have been trying have has some improvement, but because I have tried a couple of things It is hard to know which is making a difference. I have doubled the amount of magnesium I was taking as I do suffer with cold hands and feet but it is hard to know if I am absorbing it. I also formed a theory that because I usually wake with a migraine starting at 2 or 3 am. when I am having attack, that perhaps I am shallow breathing when I am in a deep sleep and I wondered if the lack of oxygen to my brain was triggering an attack. I have been trying to focus on deep breathing more especially when I feel an attack threatening. I have been migraine free for 2 weeks which is a long time for me since menopause but I am afraid I had another attack start 3 am. yesterday. My attacks last anything from 3 days to a week. The deep breathing seems to have some benefit. I was wondering whether you thought there may be some truth in my theory.
I’m not a doctor so I can only give you the perspective as another person who experiences migraine. With that in mind. If you’re waking up in the middle of the night with headache there are three things that immediately come to mind:
1) Hypnic headaches. Something that affects mostly those aged 50 or over. I’d review this article from the reliable Migraine Trust: https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/hypnic-headache/
2) As you mentioned some kind of sleep disorder. It may be worth speaking with a sleep specialist if you think your shallow breathing is an issue. The brain needs oxygen. People with sleep apnea and migraines often improve significantly when the sleep apnea is treated.
3) Sleeping environment. i.e. using a supportive pillow; not sleeping on your stomach (and pitching your neck); less common are things are a mouldy environment, very old pillows which need to be replaced etc.
I hope that gives you a few ideas Jan. Good luck!
Real menstrual migraines do not respond well to drugs for hormone balancing, oral contraceptions, hysterectomies or the off-label use of anti-depressants. Menstrual migraines can be exacerbated by numerous medications and ignorant articles such as this one. Another fact many women are learning about this type of migraine…if it is real migraine ( diagnosed by a specialist in the field), it will be in your life forever. Some ladies luck out after menopause, but most of us don’t. Some of things mentioned here, are helpful at times (chances are that if you are a real diagnosis, weather doesn’t help you either..so you can do everything perfectly, and weather will delete all your attempts, if it arrives during your cycle). The AHS, ACHE, MAGNUM and Migraine.com are the most reliable websites for migraine patients. If you want to understand how to manage migraines of any type, you must be educated properly about it. A patient can reduce the frequency or intensity of attacks with an ACCURATE education from the experts.
Hi Sheila, I applaud your efforts to find accurate, evidence based information for migraine management. If more migraine patients followed in your footsteps we’d all be better off for it.
At the same time, we all need to be careful about providing advice or guidance to others. I’m sure your experience has been true to what you describe.
But just because one thing may be true to you in your migraines doesn’t mean it applies to all others. This guide is based on evidence, research and interviews with experienced migraine specialists.
You make several assertions in your comment without context or evidence which can be misleading. For example you say that "most of us don’t".. "luck out" when referring to migraines after menopause. This is simply not true.
Most of us do improve significantly in our 50s and 60s. Furthermore, 40% of those with migraine will experience full remission by the age of 65. Given that there are hundreds of millions with migraine, it still means that there are millions of people for which this isn’t true.
In the end, much of what you said I agree with, and is consistent in the article- but not everything. Did you read the article or just skim the sub-headings Sheila?
I’m 44 years old and have been suffering with menstrual migraines for approximately four years now. It was only about a year ago though that i realized what they were as they always felt sinus related. Once I started keeping a journal i was convinced that they were definitely hormonal.
I have spent countless days and hours researching this subject and have tried numerous things to no avail.
Eight years ago my husband and I started doing home colonics along with juice fasting. I typically do this four times a year for three days at a time. This month I did this just before my menstrual cycle was due to start and to my surprise I didn’t get my usual migraine that usually comes two days prior.
I do believe that fasting helped with this! Unfortunately, after eating chocolate I ended up getting a migraine the last two days of my cycle.
Next month I am going to fast again before my cycle begins, (and avoid all trigger foods), and see if the migraines stay away. Its definitely worth a try.
Very interesting Melanie. We know there is a relationship between foods and hormones. I’ve heard from someone I know personally that their menstrual migraines stopped when she was doing the 5:2 Diet: the intermittent fasting approach from Dr Michael Mosley.
I tried fasting for some time and felt actually quite good. But hunger is also a trigger for me so I struggled to keep it up. You may well be onto to something!
YES….my menstural migraines feel like a nasty sinus infection and even carries pain into my shoulders. I am glad (no offence) that someone feels the same thing! I’ve suffered since I was 10 years old, diagnosed then with chronic migraine. My oldest son age 24) also has them (since age 5) and we’d often have them around the same day, both taking our respective space on the bathroom floor beside the toilet with our foreheads on the porcelain tank. I was diagnosed with Celiac Disease 2.5 years ago and on a strict gluten free diet, I found my daily headaches disappeared completely (so thrilled) but these monthly ones are relentless. I will give some magnesium and B6 a try next. I excercise (Yoga & walking) as well as live a healthy lifestyle, typically getting 7-8 hours of sleep per night. I am looking for an app now for keeping track of my cycle so I can be more aware of when my hormones fluctuate.
Sounds like you’re on the right track Sue!
Regarding sleep, are you waking up feeling refreshed? Sleep is an essential brain function that facilitates recovery and repair… things that are especially important when you have a sensitive nervous system. Do ensure you’re getting enough refreshing sleep. All the best!
I would like to thank you for this article.
I will be trying your suggestions out. I love that you give lots of options (especially diet & lifestyle) rather than just saying what medication will help.
I suffer migraines every month and am over taking tablets to simply ease the pain or symptoms.
Thank you again for this article.
My pleasure Kate, I’m glad you found it helpful. I hope things improve soon for you.
Thank you for this article, and for providing us with an opportunity to share our experiences. I have been suffering with menstrual migraines since my early 20s (I’m 36 now), and they have really affected my life (particularly now that I have a young daughter to look after). I also have PMDD (Pre-Mensrual Dysphoric Disorder), so hormones can really hold me hostage sometimes! In the last year I have really tackled this from every angle, cycle tracking, getting hormone testing (came back normal) and trying vitamin D, calcium, magnesium, fish oil, and 5-HTP. Of all of these, the 5-HTP has helped my PMDD the most. The last 5 months have been pretty good, even my migraines reduced dramatically. BUT- this month I had a whopper of a migraine, one of the worst I’ve had for years, and I can’t figure out why? I have food allergies/intolerances as well, and wonder if even a small amount of triggering food can have an effect that significant? I had a piece of birthday cake the day before, would that be enough to tip the balance? It’s so hard when you can’t put your finger on it 🙁 Kind of looking forward to menopause, but that’s probably not for another 15 years or so…
Hi Helen, that’s a fantastic result to hear overall. With migraine and chronic illness in general, I generally expect progress to be 2 steps forward, 1 step back. Depending on what was going on, sometimes that piece of cake might be the straw that breaks the camels back and tips you over the edge… especially if it’s during your vulnerable period of the month.
Many women are told to wait to menopause… most will get better. But not all. As you mentioned it is still 15 years out. It seems the lesson here is the keep disciplined during this period each month and keep doing the proactive strategies to keep your migraines at bay. Take care.
I definitely feel for anybody with migranes. I was diagnosed with chronic migranes 2 yrs ago from a neurologist. After dealing with these for 9 years! Dr after dr. Ive finally gotten them under control. I went from 8+ headaches/migranes a month, no life to now just a migrane on that time of month which last 3 days! Topamax 100mg and the propranolol er 60mg has prevented. I can now begin to enjoy my life again. Jeez! I also take Cambia (Diclofenac Potassium Packets) for the headaches that seem to creep up and it instantly takes my pain away within 15 minutes no side effects, ask your neurologist for a free sample.
Glad to hear you’re getting results from your treatments.
So I work night shift 5p-5a 3 days a week as an OB rn– these menstral migraines have started in the last year (year 3 of nights). I’m sure it’s related but no end of shift work in site- any tips as most of my hours of sleep even on days off come after midnight. Also if it adds anything trying to conceive
Hi Kate, from my experience there are no easy answers if you find that you are sensitive to sleep.
For me sleep disruption is one of my most reliable migraine triggers. 3-4 nights of poor sleep and I’m in trouble.
Without changing your shifts or job, the best you can do is manage all your other triggers as best as you possibly can – including menstrual migraine.
2 things to suggest on this front:
1) Discuss the principles of this article with your doctor and formulate a plan.
2) Watch Dr Susan Hutchison this April 23rd at the Migraine World Summit. She spends her entire talk discussing tips on managing hormonal migraines. If you google "Migraine World Summit" it will come up.
Good luck with the sleep and the baby 🙂
I am sure my migraines are hormonal as well. I had my first one at age 23 when taking birth control for the first time and have had them ever since (20 + years) even after stopping birth control. I often experience them day 14 of my cycle and 2 days prior to my period. As I am in my forties, they are more intense and I am also struggling with slight depression. I am interested in working on diet changes as I often crave caffeine at the onset of a headache. Can you suggest a good source for diet recommendations and meal plans?
That’s a tricky one. I haven’t come across a single best diet resource for migraine as it’s so individual.
You could explore Amazon diet books for migraine and read through the reviews to guide you. I also know the Migraine World Summit is coming out with a diet guide in late April 2017 for those who order a copy of it.
You might also be interested in reading this article: https://migrainepal.com/migraine-diet/
I hope that helps Billie.
This is excellent! I was able to stop my migraines by changing my cosmetics, house cleaning products, and other personal care items to safer brands without these chemicals.
Great to hear you have improved Michelle.
Finding a doctor is the hardest problem. I’ve been to leading headache clinics, local neurologists, obgyn, primary care- No one wants to discuss the hormone issue and if they do, no one knows how to handle it. I am suffering terribly, missing time from work and I just can not believe how mismanaged this migraine mess is. One doctor sends me to another, and then on to another- and nobody knows what anyone else has done. There is no plan, no communication. What a disgrace. It’s time for somebody to PLEASE step in and re-haul how migraine is diagnosed and treated. Good article- thanks for sharing it!
Thank you for your kind feedback.
I’d recommend looking up Dr Susan Hutchinson or Dr Matthew Robbins. Both of whom spoke about this issue at the recent Migraine World Summit event. You can still view some of their talk here: https://www.migraineworldsummit.com/public-susan-hutchinson/
Take care,
Carl
The role of the food is undeniable, the only two times i didn’t have pms migrain in the last 10 years were both when i had a stomack virus and threw up during an entire week eating nearly nothing.
Few things affect our health more than what we eat.
Ive suffered crippling debilitating hormone migraine for over 7 years now! 7 years of my life lost i cant do nothing most days but lie in bed with this horrific pain. i feel sick and am sick, weak and the head pain is unbearable and wont respond to painkillers. I get heavy flooding periods which go on for months too. Im coeliac vegetarian and try to healthy but now my weights soared even though i eat very little and no junk. I walk a few miles everyday if poss. Im 49 and had enough its miserable being in pain! The doctors have offered a hysterectomy and ovaries removed but im worried it will make the migraine worse as ive had migraine all my life. But my usual migraines though painful do react to painkillers and sleep and are nothing compared to the horrific uncontrollable hormone migraines i get. Ive had enough suffering but cant find no dr to help!
Sorry to hear about the last 7 years Helen.
I certainly would not consider a hysterectomy unless it is for another condition aside from migraine. Dr Susan Hutchinson is a hormone migraine specialist who spoke at the Migraine World Summit recently. She confirmed that having a hysterectomy is not an effective solution. You can preview her talk here where she mentions a number of effective treatments and alternatives for those with menstrual migraine. She also discusses options for those in peri-menopause or menopause and has a book which goes into more detail. Her is her link https://www.migraineworldsummit.com/public-susan-hutchinson/
I hope things improve soon!
Thank you for your article. It was very informative. Ive suffered from migraines since I was 16, so for the last 16 years I hadnt been able to attribute it to hormones, until I was done having babies and started tracking my cycles. My OBGYN has given me a prescription for Depo to try for 3-6 months. He said hes treated menstrual migraines before and seen success by leveling the progesterone. Just wondering if you thought this may help. Im a fairy healthy eater and Ive tried magnesium supplements in the past, however the magnesium is hard to keep up with as its a pretty high dosage daily.
Hi Megan,
Your doctor is going to be the best person to decide if Depo is going to be helpful for you. Only they have your full personal history, diagnosis and health profile and given this indepth understanding be make personalised and informed recommendations. I’m not a doctor, just a patient like you.
I take a high dose daily chelated magnesium at the moment and don’t find any issues with compliance once you get into a habit.
Kind regards,
Carl
I have a very difficult time with menstral migraines. I usually get a migraine at onset of ovulation and then another at the onset of my cycle and then another after I complete my cycle. Although I have found that increasing magnesium, vitamin D, B12, Coq10, do help to lower the attacks. I also experience painful cramps and heavy flow during my cycle although since I only drink water or unsweet green tea I have found that my flow hasn’t been as heavy, yet the painful cramps are sometimes unbearable. I have at least 3 cysts in my reproductive areas (1 on each ovary and the other on my cervix) which also contributes to the overwhelming pain and cramping during ovulation and my period. The pain also makes sex very painful so there’s a huge in the desire of sex. It’s difficult for my husband to understand and it has taken a toll on our marriage. I have changed my diet to nearly gluten free thanks to my Chiropractor. I eat skinless chicken and wild caught fish and try to avoid other meat choices to 1 to 2 servings a week and I’ve increased my fruits and vegetables by buying fresh produce and either freezing it myself or using them to make salsa and other sauces so there’s no additives or preservatives. I also cut as much sugar as possible from my diet since I also have digestive problems such as IBS D and GERD and I have noticed that I do feel better since the change in diet. But I also know I am not out of the woods yet as last week alone I had a week long migraine with nausea so bad I couldn’t keep anything down and I felt as though I was on a continuous merry go round with no power to stop the spinning and balance issues. I suffer from Vertigo often and I felt so sick I nearly ended up in the ER I’m tired of medicines that don’t work since I have gone thru all the low cost migraine medicines and still find little to know relief for my migraines that I wish I could either get a prescription for medical marijuana or put a bullet in my head and simply end my life. Don’t get me wrong I don’t want to die I just want pain reief without being a pharmacy.
Hi Laurie, migraine is frustratingly difficult, complex and the lack of understanding from most others makes it even more challenging. But rest assure it is worth all the effort. There is hope and even if nothing is working for you today, there are some very good treatments on the way.
Take care,
Carl
Bullseye with this article. I am a 35 year veteran of both migraine and more severely, menstrual migraine and can vouch for everything written above. I have done it all the western medicine way enduring operations, narcotics and a staggering list of prescriptions with the help of neurologists – Duke University headache specialists to be exact – but it wasn’t until I got online and did some common sense reading that I realized I needed to do a full overhaul of my diet, medicine intake and life in general as well as adding the big E (exercise!). In the past 8 months I have gone from having an MRI because my doctor’s and I both felt that the imaging would show something terrible – getting the results that everything was normal (and breathing easy for a second then freaking out about my symptoms because they were real and I was being told it’s nothing) to slowly getting my head wrapped around the idea that I am exacerbating the pain and fatigue and depression – then low and behold I did a gentle colon cleanse, started drinking at least 64oz of water daily, added Jane Fonda yoga and then worked up to her cardio aerobics, cut out breads and added a lot of salad, fruits and yogurt (not starving myself, not forcing foods I dislike but also removing the yummy but terrible carbs and processed crap from the cabinets) and played around with a lot of different herbs and minerals (methyl b12, citrimax blends, magnesium, feverfew, vitamin C from whole food sources are just the tip of the iceberg) while continuing the Verapamil (Calan to some) and acute use of my triptans during my cycle but slowly 86’d the Excedrin migraine and only allowing natural caffeine sources instead with a nsaid pain reliever as needed. I want to also mention that I didn’t eat like a typical American to begin with – I have never been a soda drinker, I might’ve eaten fast food once a month and even then I didn’t eat the fries and ate a pretty balanced diet to begin with so I had to make major modifications and experiment with which foods were the base of my problems and like a lot of women, yeast is my enemy…So it is my great pleasure to proudly state that I HAVE NOT HAD A FULL BLOWN MIGRAINE AND/OR MENSTRUAL MIGRAINE FOR 3 MONTHS RUNNING! I am loosing the weight, the brain fog has lifted, I can poop (hallelujah) and I just feel better. The supplements that I have ultimately stuck with include: Smarty Pants adult multi vitamin with fiber, feverfew, magnesium malate, tumeric curcumin with piperine, citrimax blends, an herbal water weight loss (cranberry, dandelion, green tea amongst other things) as needed for water weight around my cycle and during the high heat days in summer to assist with spinal pressure, CLA to get thru the fatigue speed bump that loves to show up during my workouts AND THE BIG GUN: ENLYTE-D (only sold by Direct Value Dispense: 985-629-5742) it contains 6mg L-methylfolate magnesium, 2mg methyl b12 (not a ton but a good base amount to add to if you like), 25mg P5P, 5k iu vitamin D3, 25mg magnesium-L-threonate, and 25mg zinc ascorbate. This stuff is a game changer. Anyone who struggles with pain, fatigue, mood and/or attention -basically the entire American population- should give it a shot. It’s a bit pricey at $120 for a 3 month supply but that goes along with a point made in the article – quality costs! So don’t waste your money – just talk to people who are supplement snobs, read the reviews and don’t down a bunch of expensive herbs unless you are eating and drinking, sleeping and exercising in a manner that will allow the supplements to help! Lastly, I wanted to give you a few of my favorite brand names because a lot of time, research and money went into this list and I just wish I could have had a clue about it all when I started my journey! Smarty Pants gummies, NOW, NatureWise, Himalaya herbal healthcare, Jarrow and Solaray are great and affordable. Also, I have used Thorne Research, Herbal Secrets, Nature’s Way, Zen Principle, Pure Encapsulations and my personal favorite for "easygoing" is GoEasy by Be Whole Integral Formulations. I always keep a comparison of the costs of my supplements between Amazon and Walmart.com and I greatly recommend investing in an Amazon Prime account. It won’t take long for it to pay for itself! In conclusion, I would just like to say that you are not alone in the headache world and I hope my experience can help you with your own journey. Eat like you know you should, drink that water and search Jane Fonda yoga and/or workout to get going. I truly hope you feel better and thank you for hanging in there and reading this post. Lindsey Connolly – daughter, sister, wife, mother and Duke"neuro" survivor…
Hi Lindsey,
Fantastic to hear about your improvements! Thank you for sharing such a detailed account of what you tried that helped turn the corner for you. This will be a great help to others.
I’m actually collecting patient case studies at the moment and would love to capture your story in a more structured way for others to learn from: if you have a few minutes please visit: https://migrainepal.com/casestudies/
I hope you continue to enjoy your success!
Thanks again,
Carl
My personal experience has led me to believe the hormones within meats are effecting us much more than we know. Ever since my sister has convinced me to go vegan I havent had one migrane before/during my period since and I used to get migranes for a whole week every month. Migranes do the brain serious damage over time and its important to try stop them from occuring. Im not saying cutting out meat (and sugar around your period if you can) will help you but it worked for me and im over the moon and wish i did this earlier. I know other women who have also tried cutting out meat and ive noticed a significant improvement in their moods alone. Good luck everyone! <3
Wow, that’s very interesting Jess.
I’m increasingly reducing my animal protein as I discover more about the reality of these meats, the drugs used and the health of the animals that we later consume.
Thank you for sharing.
I have had hormonal migraines for about 16 yrs. they start the 3rd day of my mental cycle and last about 3 to 5 days afterwards. The doctors have tried numerous diets and medication to no prevail.
See below for my response 🙂
The only thing I found that works is marijuana. It kills the pain but only for a few hrs and I can’t work like that. One more reason to legalize it. Unfortunately you can’t run a business while your under the influence. I wish I could find something that worked
Hi Kg,
Don’t give up. If your migraine attacks are triggered by hormonal factors than that will be a big key to solving your condition.
The answer is there somewhere.
They are a few specialists who understand hormones and migraine extremely well. Two people to consider looking up, reading about or booking are Dr Anne MacGregor and Dr Susan Hutchinson.
Good luck!
Carl
Hi – I have had menstrual migraines for years and I am now on the mini pill (aged 53) so no periods. But get spotting some months and headaches every other month or so. I am also peri menopausal so hormones all over the place. I eat healthily but should do more exercise. I have been hospitalised a few times because of non stop vomiting and severe pain. I take propranalol every night and not sure if it is working. In pain today. My daughter (age 24) has unfortunately inherited migraines and has a menstrual migraine every month. Thanks Julianne
Hi Julianne,
A migraine diary is a helpful way to evaluate whether a treatment is working for you or not. You can track your days and attacks and then compare performance when using or not using your preventative treatment – propranalol.
Please do this under the supervision of a doctor. Sudden withdrawals can lead to severe symptoms if not properly managed.
Two headache diaries worth considering are Migraine Buddy and Curelator.
I hope that helps,
Carl
I have been suffering for 16 years myself, trying medication after medication. I hate trying to explain to someone the pain of a migraine, it is NOT just another headache. This is something that changes your life completely. I am going to start the botox treatments soon I hope and pray that they give relief.
Hey Deniz, if someone asks you to explain migraine I’ve written a letter for exactly this purpose (after I also got sick of explaining it over and over) here: https://migrainepal.com/letter-to-people-without-migraine/
I hope your Botox treatment goes well. Good luck!
Carl, Im glad you you are diligent enough to have found what works for YOU and have found a way to use the info to employ yourself and help others.
However, the title of the article implies that it can be done, and somewhat easily or routinely. NOT SO.
Eliminating menstral migraines has been studied FOR MANY YEARS and NO ONE ANYWHERE ON EARTH has unraveled the complicated nature of menstral migraines, or how to stop them. If they had, the answers would be as known and wide spread as birth control options, and the researchers would be reclining on a beach or golfcourse somewhere in the world, very rich.
There ARE STILL some things unknown to the world AND medical community, and menstral migraines are one of them.
I have seen specialists and endured menstral migraines for at least 34 years.
Hi Di,
I’d encourage you to read through some of the clinical research published by Dr Anne MacGregor and Dr Susan Hutchinson- both leaders in the field of menstrual migraine who get very good results with their patients. It can be controlled with the right support and information. There are certainly people with very difficult cases.
My goal with this post is simply to give people some ideas to discuss with their doctor. Thank you for your comment.
Hi I suffer each month from migraine. I am unable to get on with normal life for about one week. During this time I also experience anxiety. I try to just get on with things the rest of the time but after the migraine my vestibular system is in disarray. I have seen Consultants to no avail. I hope I can at sometime in my life get some relief. Thank you Jackie
Hi Jackie, see my above comment to Di where I reference two specific experts on this topic. Getting to see them or someone like them could make a big difference. Or even looking up their work and research publications.
I have had menstrual migraines every month for 20 years. I’m now 47. I had a brief respite when pregnant with my 2 babies – heaven!
In the past 2 years I have used a Triptan in the form of a nasal spray. It has been life changing. Previously I would have been barely functioning for 6 days every month. Now I am more in control when I know an attack is imminent and the spray works VERY quickly – usually by the next morning i am completely sorted.
It took me several attempts to get a sympathetic GP who agreed to prescribe them as they are more expensive than the tablet equivalent.
That’s a fantastic result Ally! Congratulations. I hope your improvement continues into the future!
Hi I have been suffering with migraines since Ive been 15. Migraine and menstrual migraine. I was diagnosed as chronic migraine sufferer. I am 37 and I feel my life is dominated by my migraines. I am miserable I have twins and most of the time I am in bed as I can’t lift my head. I am in a desperate situation. My dr just gave me pindolol which are beta blockers so far they don’t seem to be working. I will start the magnesium 500mg daily and will speak to my gynecologist re estrogen and progesterone. When I was pregnant I did not get any migraines it was a total Miracle. I remember taking progesterone during pregnancy. Carl please give me some advice as I feel my life is going nowhere because of my daily migraines. I do not exercise I have to admit and diet not the best 😲 Thanks Kim from Malta
Hey Kim,
I’m not able to provide any medical advice as I’m not a doctor but I’ll give you some thoughts to consider.
Firstly, I appreciate your honesty about the exercise – and I can understand, with chronic migraine and twins, who would have the time?
With magnesium I’d suggest speaking to your pharmacist about Magnesium chelate ( it’s a category of magnesium that is better absorbed) i.e. magnesium glycinate 200ml twice a day (with food), so a total of 400 per day. You can build up from there. But that’s a good starting point.
If you were migraine free during your pregnancy then that is the secret to your improvement. Your hormones. If you can find a hormone and migraine specialist like Dr Anne MacGregor or Susan Hutchinson (you can google them) then they can help regulate hormones and bring things under control.
There is definitely help and options. Having a detailed diary with the exact days in your cycle is very important to bring to those consultations. At least for 3 months. The day can determine the potential treatment.
I hope that helps Kim, take care and good luck!
Which spray ?
I use a heavy dose of Naproxen from 3 days before my period to 2 days into my period.
Does that work for you? Another treatment that might be suggested is a long acting Frovatriptan. But not everyone can take triptans so best to check with your doctor.
Hi Carl,
I just turned 32 today and am at a loss about my menstrual migraines. I get long 3 week stretches migraine-free, but a few days before my period and for up to 9-10 days after, I have On and off menstrual migraines. It’s the main reasn why I can’t commit to volunteer work or full-time work. And I wonder how I’ll get along once husband and I have children. Before my migraines were not predictable. Today, I am aware of most of my triggers, track my cycle, reduced my work load, was a consistent sleeper, and I am gluten and dairy free because testing shows I am intolerant to both. Because of that, now I can at least predict migraines and the symptoms are not as bad as they were. Still, this time around it’s felt worse, and I am certain some sleep disruptions have been the culprit because I usually have a very consistent sleep schedule but not this past month. I also ate a lot of soy for this past Lenten Friday, and I never eat soy. I also don’t exercise very much, despite having a gym membership. Bottom line, I don’t want migraines impacting my marriage and my ability to maintain responsibilities and maintain a home. My husband has been very understanding and patient, but I’m tired of letting him down. We are strongly desiring of children but I need to pull my weight more. If you have any other advice, I’d love it. I’m going to try to resolve or sleep habits, no more soy for me, and will start exercising. On another note, I am very petite and a slim weight so I don’t have weigh issues. Thank you!
I forgot to mention, I struggle with shallow breathing and anemia especially one week before period.
Shallow breathing that causes me to doze, not so much anxious shallow breaths.
Hi Jade,
I’m not a doctor so can’t give you personal medical advice. But what you describe in these comments sounds like menstrual migraine for which there are a number of potential treatments for. Low dose estrogen to even out the monthly cycles may be very helpful.
During pregnancy you might find your condition either improves remarkably or worsens… but whatever the change it usually returns to normal once breastfeeding stops.
My advice would be to see a ob/gyn who has had success working with patients with migraine. There are effective treatments available and you’ll need specialist advice over the pregnancy. Ideally they should work with your headache doctor to optimise your treatment.
Don’t feel guilty about it. You didn’t ask for this and you’re doing the best you can.
I hope that helps Jade. Take care,
Carl
I had a doctor tell me I could either induce menopause (but I’m only 38) or suffer through my monthly migraines. I used to get them very predictably on the day of heaviest bleeding. Now they’ve shifted to just before my period starts—again, very predictably. They are very painful and hurt in my head and neck in addition to in one temple. They’re so disruptive, and I dread my period each month because of them. But yes, a week of breast tenderness pre-period, then a day of difficult pms, then the headache, followed by a couple more days with less intense headaches. Acupuncture helps a bit if the appointment is timed exactly right, but that’s rare. I know this blog post is older p but I’m wondering if you have insight. Thanks.
I’d get another opinion from a OB/GYN who has had success with migraine before. There are effective treatments available. This blog has been recently updated. Also, Dr. Anne MacGregor, a world leader in this field is interviewed at the 2018 Migraine World Summit in April on this topic. Don’t miss her instructive talk.
This is helpful but I’d like to know how being on birth control affects hormonal migraines especially since menstruation is not technically happing while on hormonal birth control. I suffer from occasional migraine usually right before I start my “period”. I’ve been on a low carb/ketogenic diet for 2 years, so my diet is pretty clean of sugars and grains and it has significantly reduced my migraines but not eliminated them entirely. I’m about to go off the pill and I’m hoping that will have a beneficial impact on my hormonal migraines.
I didn’t make the connection when started taking birth control but I believe that is when my migraines began.
I’m also finding dehydration a trigger for certain migraines and will be upping my magnesium intake by taking electrolytes.
Hi Lisandra, birth control pills can help regulate the highs and lows of naturally occurring hormones in women that can trigger migraine attacks. It’s not appropriate for everyone.
A world leading expert is discussing this topic next week at the Migraine World Summit in detail. Google the event for more details and look for Dr. Anne MacGregor.
Thank you so much for this. Myself and my two daughters have been experiencing menstrual/hormonal migraine for many years. I have had them since the age of 13. I am now 53 and menopausal. My migraines are out of control (as in severity and frequency). My daughter who is now 22 has had them since she was 8 years old. She always had an attack around MY menstrual cycle. Her migraines are so severe she throws up for hours. She has an aura which we have coined "the blurry thing". She was actually in the ER last night because she had dysphasia and was so dehydrated from throwing up so much. I am at my wits end trying to help her with these. I cannot imagine her going through 20 migraines a month when she goes through menopause. HELP! We have done whole 30 (no sugar, no processed food, etc.) We have tried progesterone cream, cut out dairy, cleaned up our diets to no avail. We are considering going to an endocrinologist for help. What do you think?? I am willing to do anything to help my daughter/s combat the pain!
Hi Dayna,
If you have migraine with aura then it’s not menstrual migraine. You can have menstrually related migraine which may be a combination of pure menstrual migraine and then attacks at other times of the month. From your description, this sounds like your daughter.
I think you’ll find better results with a headache specialist then you would an endocrinologist. Note: a headache specialist and neurologist aren’t always the same thing. Headache specialists are used to seeing women where hormones are a big factor. I’d also look up some research and studies done by Dr. Anne MacGregor. She is a world-leading specialist and researcher in this area.
Thanks for the article. My sister and I both suffer hormonal migraines like our mum did before menopause. They occur just before or at the beginning of a period. Has anyone experienced a positive result by having the daith piecing done? My doctors offer no help and I end up just riding it out. I get anti-nausea injections when I am bad and can end up in hospital on drip if I can’t control the vomiting. So over these headaches!
Hi Michelle,
There have been many comments and feedback about the daith piercing on this article https://migrainepal.com/daith-ear-piercing-for-migraine/ you might like to read through them to see if anyone mentions treatment for menstrual migraine. There is not any reliable scientific evidence on the daith piercing to date.
Nothing in this article relating to how a person handles themselves emotionally consciously or unconsciously. As if our hormones make us perceive a particular way.
Hi Ted, I’ve written about the emotional challenges of living with migraine in several other articles on this site, including here: https://migrainepal.com/letter-to-people-without-migraine/
I struggle every month for 7 days a menstrual migraine. Nothing has helped it so far. This has changed my life and really depresses a person.
Understandably Stacey, I hope this article has provided some clues.
Stacey, severe and uncontrolled migraine is depressing for anyone. I hope this article has provided some clues.
Hi. I am 21 years old and started having migraines that lasts about 2 whole days when I was 16. I was on depo in high school and it made them 10 times worse. Was having 6 a month. Went to so many doctors and nothing. Then went to the pill and that was just as bad. For the past 2 years I have been on nothing except just being careful when having sex. I now have a 2 day migraine two days before my period and 2 days at the end of my period. No meds. Help at all pain ones. It has got to where I have lost 3 jobs because I can’t come in sometimes when I have them. They get so bad I throw up the entire time. Most work places don’t understand that they happen. I had one boss that said just work with a headache it can’t be that bad. I said yes it can. I am now married though and have been trying to get pregant for 6 months now. No luck yet. But I don’t take any meds because of it. But my question is if I do get pregant will they get worse? And also what could I do to ease them without meds? I exercise with my dogs daily. Work full time and I get 8 hours sleep everyday. I also make sure I eat 3 meals a day and 2 snacks in between those meals. Normally something like nabs or some type of fruit. I drink no sodas. And I keep sugar to a low because I do have high sugar levels since I was a kid. I am always looking at new things to try to help with the migraines. So maybe someone here may know something I can try but be safe to try while trying to get pregant. Wish me luck. Thanks in advance.
Hey Michelle, he good news is that most people experience significant reprive from migraine whilst pregnant. Sometimes the improvement continues after the baby, other times it doesn’t. For two leading experts, both who have written books on the topic of migraine and have websites which also likely include more information about pregnancy and hormonal migraine are Dr. Anne MacGregor and Dr. Susan Hutchinson. Both are well known hormonal migraine experts who’ve had plenty of experience with pregnancy and migraine. Good luck!
Thanks for this guide. I’m going to start keeping track of the days that I have a headache and of my diet. I hope it turns out to be this easy of a fix. 🙂
My pleasure Esther. Good luck!
Thank you so much for this article. I have been suffering from migraines for 4 years. The last 2 years it has been more severe and happening more often. Last year I was diagnosed with endometriosis, and had the extra tissue removed. My obgyn and primary doctor said the endometriosis was not related to my migraines. I feel that is false, that some how it’s connected. I have been taking notes on my cycle for the last 3 months, and find I have a migraine right before my cycle, right after my cycle and during ovulation. The migraines are always on my right side and last at least 8+ hours. This has made it very hard for me to have a normal life. It’s hard for me to have a job because no one wants to deal with someone calling in sick up to 3 times a month. It looks very unprofessional, and causes me stress, which is also a trigger. I decided to quit my job and work on my health. I was managing a restaurant/bar and the hours/stress/lifestyle was not helping with my migraines. I have started to change my diet to more fruits and veggies and less red meats, and less dairy. Plus I am exercising at least 3-5 times a week. I feel it is helping, but the migraines haven’t completly stopped. In fact I had one last night that lasted until 5pm today. I looked up my cycle and ovulation starts tomorrow. I am going to try the magnesium. I hope it helps. I think I have a lot of triggers. I worked for a wine bar and started noticing wine is a big no no for me. Now I don’t drink any alcohol. I know sugar is also a trigger. I use to be able to eat all the sugar I wanted and drink without any issues. But when the migraines started that all changed. I did the keto diet for a month but I was eating brie cheese which also might be a trigger for me. I never drink soda but I do need to drink more h2o. I haven’t met anyone that understands what I’m going though so the support from others is welcoming. Friends and family just say man you sure do get a lot of migraines…as if I should be able to prevent them. I am trying but I must be missing something. I plan on doing a 30 day urine sample to check my horomes. My chiropractor told me about it and gave me the kit to send in. It costs $250. Let me know any useful tips. Thank you!!!
Hi Tamara, make sure you request a chelated form of magnesium… it’s much more readily absorbed. i.e. magnesium glycinate.
I tried the keto diet. I would get my fat intake from avocado, coconut, high quality grass-fed butter and nuts. It helped but I also had raised liver enzyme levels so I had to stop at the time. Always good to be working with a good doctor through these things.
The best prescription is education… keep researching and learning about your condition. It will give you ideas, make you more confident and improve your ability to control your condition. It is possible! Good luck!
Avocado is a huge trigger for most (see HYH migraine diet)
Not for me personally. I love it. Healthy fats!
I’m 43 years old and I started experiencing migraine attacks just last year. The attack would happen usually a day or two before my monthly period. Reading this article is very helpful. I now have an idea what to do about. Thanks!
Hi Vina, I’m glad this helped. Make sure you get a qualified doctor to diagnose you with migraine. Later-life onset (rather than before 25 years old) is less common so sometimes you might need to be checked for other potential causes.
Hi my name is Diane and I’ve been suffering from migraines for probably 49 years, I’m 52. They are definitely menstrual migraines because they begin at least a week prior and are constant. I can take my migraine medication and it will go away but then it always returns 🤯. I get very very fatigued before my period as well. There are times I will also get this itchy rash on my upper thighs. This is very frustrating and depressing.
Hi Diane, sorry to hear about your situation. Menstrual migraine is a difficult cycle break and very difficult if you trying to do it alone.
I’d strongly encourage you to work with someone who has successfully treated menstrual migraine before (preferably many times). There are experts out there. People like Dr. Susan Hutchinson in the USA and Dr. Anne MacGregor in the UK.
In regards to my previous post, I’ve been suffering for 40 years, not 49.
This is one of the best written articles regarding menstral migraines that I have found. Every month I find myself doing the same old song and dance trying to figure out what in the world I can do to save myself.
Nothing works.
Thank you for the info.
Thank you Jenni, I hope this helps reduce your attacks or at least gives you more confidence about what’s going on and how you may control it.
I’ve had menstrual migraines for about 20 yrs now. I’ll be 46 in Nov. No children. My doctor wants me to take Propranolol in addition to the Sumatriptian+Naproxen I already take. I politely refused. This is why. Way back before I started Sumatriptian, I would have one headache a month. Sometimes, just when I thought it was over, it would switch sides and I’d be down for another couple days, BUT after that, the rest of the month was pain free! After Sumatriptian, I started having renound headaches, headaches before and after my period and in the past few years, Occipital headaches. I try to take Excedrin Migraine when I can and coffee, too and all that plus Sumatriptian just makes me sick and dizzy. Now, I can’t say for certain that ALL those changes are due to meds and some may be due to age or stress. I will say that none of my doctors has ever suggested hormonal balance checks or natural remedies even when I asked. I am now monitoring my diet, but there has never been a trigger food for me. I brought up non THC, CBD oil to my current doctor and he says that’s a last resort. I’m very nearly prepared to take it anyway.
Hi Angie,
Proranolol is a preventive treatment for migraine. Sumatriptan is not. If taken too often sumatriptan can lead to medication overuse headache (MOH) or rebound headaches. See this article for more details.https://migrainepal.com/rebound-headache/
From the guide in that article you should get a better understanding of whether you are at risk of MOH or not. Also, for women around your age perimenopause can be a tumultuous time for migraine attacks.
A preventive treatment may really help but if you don’t like the sound of propranolol, there are others. For example those listed here: https://migrainepal.com/preventative-treatments/ I hope this helps.
Thanks for this. But you make it sound like migraine is just an absence of a chemical in the body, like a drug, as if everyone needed to be medicated to be even comfortable. The can heal itself with the right help. I had migraines since I was a teen and I too Imitrex daily for over a decade. Two years ago I came across a healer who completely got rid of my migraine headaches. It was Manfred Mueller from HomeopathicAssociatesdotcom. It took six months, I and have not had a single migraine. And the best part—it was all over the phone. They told me what remedies to take and I took them. I have not had a single migraine in a year.
That is a fantastic result Rachel. Congratulations. I agree with you that the body can heal itself… it does this all the time. Sometimes we do need extra help to heal. I haven’t seen any studies supporting the efficacy of your treatment. But the absence of evidence does not always mean the absence of efficacy.
Great article! Thank you for sharing your experience and research. Reading through all the comments is another proof how each migraineur is a unique individual with the challenge to find what works for them specifically. I also appreciate how caring you responded. I have lived with migraines for 33 years now. My first onset was a traumatic experience with the left side of my body going tingly and numb, then the right side. I thought I stubbed my foot in the cement pool floor at first. By the time I got out of the pool to open the locked door I had to hobble in and up the elevator. When I reached out condo I was frantic and my mom helped calm me, but by the time we were ready to go to the Dr’s, both sides were numb and I could not dress myself although I tried (couldn’t the me shoes, button my blouse, or drink water without dribbling). At the doctor’s office I had episodes of blacking out and saying things that were not true (thankfully only to my mom). I went to the children’s hospital for testing and my dad stayed with me. The excruciating head pain along with nausea and vomiting set in, which continued after my hospital stay. Our doctor stated that this was a migraine with onset due to hormone changes, MSG, and the use of Nintendo games (which was brand new to the market). My migraines are hereditary, my paternal grandmother had them, my dad had one in his life. I have not ever experienced another episode like that but currently have had over a year of chronic migraines. I went into remission during pregnancy, but after my third son had another chronic year, then I had 2 more boys over 5 years (mom of 5 boys and so happy for each) and years of less migraines. A neurologist shared a long list of food triggers that I stick to. My chronic migraines are hormone related with also learning of new food or other triggers. My PA has been very helpful this past year with tests and trying to figure out a treatment plan. With a low estrogen birth control pill (first full year ever on one) I at least know when my hormone triggered migraines will come. Like so many others, it is hard to go through and the past year has been rough, but I have learned a great amount on many levels. I started an all natural supplemental health system and have cut down my 16-18 migraine days per month to 11-12 with this month on track to being less. I have learned the pathophysiology of migraines along with reading several articles over this past year of this migraine journey. From your article I learned some things that I had not before read, the point about the liver’s role concerning our hormones. I also learned that there is a yearly migraine summit, which I did not know. I never quite believed migraines were caused by blood vessel dilation/constriction that was theorized for years. Our migraines have numerous factors, including genetic code differences. We each suffer in different ways and a diary of keeping track of symptoms along with food/liquid intake is a great start. I have learned about pre migraine symptoms and post migraine symptoms by keeping track on a small pocket size notepad and calendar. As an Oncology RN who works nights, I am grateful for my intermittent FMLA that helps keep my job secure. I may have to live with migraines all my life, but I am stronger for it. Each individual has something they go through and our kind compassion to each person whether they suffer from migraines or another ailment helps, especially when we are kind to ourselves. Thank you very much for this article and sharing your knowledge.
Something else that has been on my mind is if cerebral spinal fluid levels fluctuate during migraine episodes and if that has any role in the chemical messaging system involving hormone levels. There is such a delicate balance needed and having the right balance or finding it is like a difficult treasure hunt.
Not to my knowledge. But there is such a thing as high and low-pressure headaches which relate to the CSF in the brain.
Hi Sharlin, this is the first time I’ve heard of Nintendo games being a migraine trigger from a doctor. Lol.
Thank you for sharing your experience. You’re right. Everyone is an individual. I am too am stronger and healthier because of migraine. There is solace in that.
Hi Carl, this is a really helpful site – thank you. My migraines started at age 9 as typical migraine with visual aura – spreading zig zag lines, then severe throbbing headache, nausea and vomiting. They weren’t very frequent but increased when I started the COCP at age 19, so my doctor switched me to the mini pill. I didn’t have another episode until I was pregnant 19 years later and this time it was just the aura, no headache thankfully. During that and my second pregnancy I had a few similar episodes of visual aura only, no headache. Now at age 47 they are more frequent and I know are related to hormonal fluctuations but I’m perimenopausal with irregular periods so it’s difficult to track them. I’d like to ask my doctor about starting HRT for other symptoms. I’m fit and well, but my mum had an ischaemic stroke aged 48 (no migraines). Is this a contraindication? I’ve also wondered why I now just experience the aura (lasting 20-30 mins) with no headache (although I do always feel a bit hungover afterwards).
Hi Ed, migraine evolves over time. It is very common to experience a change in symptoms or a shift from head pain to other symptoms such as the aura you mention. Regarding your family history of stroke that’s something your doctor really needs to evaluate on an individual basis. The dose and type of HRT may also affect the risk so there may be more than one option available to you. I hope that helps.
I felt this didn’t answer the question about removing the ovaries. First, the article says:
“A hysterectomy with or without the removal of one or both ovaries increases the risk of migraine.”
But then the article says:
“Menstrual migraine attacks are caused by a fall in hormones which are triggered by the ovaries. Whilst menstruation stops with a hysterectomy, it does not stop the ovaries from continuing to produce monthly hormonal fluctuations which can trigger migraine.”
According to the second quote, it seems that removing the ovaries should remove the source of the problem – the hormonal fluctuations produced by the ovaries. So why would removing the ovaries increase the risk of migraine. Do doctors argue against removing the ovaries simply because it is surgically invasive?
Feeling like you want to end your life because of three-day migraines every two weeks because of menstruation and ovulation is a hell of a lot more invasive, let me tell you.
I’m nearly 47, already have my three children, and that’s how often I get migraines, while I’m trying to look after the little kids.
Could you please explain clearly why I shouldn’t have my ovaries removed?
Should probably add that over the years, I’ve already tried for prevention Lyrica and Endep, and I currently use propranolol and magnesium. Pain relief has been aspirin, paracetamol+codeine, Endone and Palexia (tapentadol). Maxalon for nausea. Nothing treats the exhaustion. Thank you.
This might sound silly but good sleep is important for exhaustion. Good quality sleep takes into account duration (how long), quality (not lots of broken sleep, not having untreated sleep disorders like sleep apnea etc) and consistency of sleeping patterns.
Hi Catherine, I interviewed Dr. Anne MacGregor, a world leading in migraine and hormones on this topic and this is what she said to me:
I hope this makes it a little clearer – she is more articulate than myself. If not please let me know.
Thanks very much for your reply. I’ve only just seen it now. Yes, thank you, it does make it clearer.
Here are some non-vague tools THAT WORK:
MAGNESIUM GLYCINATE (w/ no fillers like a pure encapsulations type) at night
MAGNESIUM THREONATE in the morn (no migraine trigger fillers like gelatin)
Prometrium progesterone in your luteal phase – look up Dr Jaquilynn Prior
the HYH diet
real ginger every morning (mine’s in my morning tea) as its efficacy proven in trials equal to sumatriptan
HIT exercise
no grains, titrate down to no coffee for a couple months if you are really desperate – then add foods back in to see what is a trigger
migrainestrong group on facebook a wealth of info.
Wish someone had told me these things, hope they help, they did for me.
*I know no one nor no one at any brands mentioned.
A good Massage therapy is a great way to relieve the chronic headache that you feel. With the help of a pure kind essential oil.