Headaches & Periods

Menstrual Migraine: Why It’s Underdiagnosed and Undertreated

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Last updated: February 7, 2024

Many women experience headaches during their period, with migraine being particularly common before, during, or after menstruation. This condition is known as menstrual migraine, which can be classified into two types:

Pure menstrual migraine: Attacks occur exclusively within the two days before or during menstruation.
Menstrually associated migraine: Attacks predominantly happen during menstruation but can also occur at other times in the cycle (e.g., around ovulation).

Menstrual Migraine: Underdiagnosed and Undertreated

Research shows that nearly 50% of menstruating individuals experience tension headaches or migraine during their period. In about 60% of migraine sufferers, attacks occur more frequently around menstruation.

Despite this, menstrual migraine is often underdiagnosed, with many women waiting years before a doctor recognizes the connection between their migraine attacks and menstrual cycle. This delay in diagnosis means many endure severe attacks unnecessarily, despite the availability of effective treatments.

Menstrual migraine is part of a broader category of underdiagnosed cycle-related conditions, such as endometriosis and polycystic ovary syndrome (PCOS).

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Longer, More Severe, and Harder to Treat: Menstrual Migraine

Menstrual migraine attacks last longer (often 2–3 days), are more intense, and are harder to treat than non-menstrual migraine attacks. They are also more frequently accompanied by nausea and vomiting.

Even with medication, treatment is often less effective—many women experience rebound headaches after taking triptans, a common migraine medication. Research highlights the significant impact of menstrual migraine on daily life, childcare, and work, with premenstrual attacks (1–2 days before menstruation) being particularly debilitating.

Causes of Menstrual Migraine

Menstruation is one of the most common migraine triggers, likely due to the sudden drop in estrogen levels before menstruation. It’s not the absolute estrogen level that matters, but the magnitude of hormonal fluctuations.

For example, migraine often improves during pregnancy (after the fourth month), when estrogen levels stabilize. However, migraine attacks may worsen after childbirth, as estrogen levels drop again.

The good news? After menopause, estrogen levels stabilize at a lower level, and many women experience a significant reduction—or even complete disappearance—of migraine attacks.

Headaches & Periods: Treatment Options

If you suspect a link between your migraine attacks and menstrual cycle, consider tracking your symptoms with a headache and cycle diary for several months. Discuss your findings with your gynecologist or healthcare provider to explore options for acute treatment and prevention.

During an attack, pain-relief medications, rest, and relaxation techniques can help—plus, these methods may also alleviate menstrual cramps!

For prevention, options include both medication-based and natural approaches. One promising natural method is low-glycemic nutrition. Did you know that keeping your blood sugar levels stable can help prevent migraine attacks? Studies suggest that blood sugar fluctuations can trigger migraine.

Conclusion

When migraine attacks frequently coincide with menstruation, this condition is referred to as menstrual migraine. Although it remains significantly underdiagnosed, more than half of women who suffer from migraine report that their attacks tend to cluster around their menstrual period. In diagnosing menstrual migraine, two distinct types are identified:

Pure menstrual migraine, in which attacks occur exclusively within the two days before or during menstruation.
Menstrually associated migraine, where attacks also frequently occur during menstruation but may additionally appear at other times throughout the menstrual cycle.

A drop in estrogen levels at the beginning of menstruation is suspected to be the main trigger for these migraine attacks.

Menstrual migraine attacks are often more severe, last longer, and are more difficult to treat than other types of migraine. They are also more frequently accompanied by nausea and vomiting. Additionally, many sufferers report that their response to acute medication is less effective compared to non-menstrual migraine attacks.

There are several preventive strategies for migraine, both medication-based and non-medication-based. One promising approach is the regulation of blood sugar levels, as large fluctuations in blood sugar have been found to trigger migraine attacks. With Ebby, you can determine which foods help keep your blood sugar stable and low, thereby reducing the frequency and intensity of your migraine attacks.

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Mechsner (2016): Endometriose. Eine oft verkannte Schmerzerkrankung. In: Der Schmerz
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About the Author

Stefka Lysk

Stefka is a qualified psychologist. She provides outpatient psychotherapy to patients and teaches relaxation techniques and doctor-patient communication at the Charité.