Most female migraines [Menstrual migraines] are believed to be closely associated with a woman’s menstrual cycle, due to changes in the levels of estrogens during the menstrual cycle. Estrogen levels decrease before the menstrual flow starts.

When estrogen and progesterone hormones drop to their lowest levels it is not unusual for a Premenstrual Migraine to start. Whilst female migraine attacks are expected to disappear during pregnancy some women have experienced migraines during the first trimester but absent after the third month of pregnancy.

Interesting points about menstrual migraines, menstrual cycle and pregnancy:

Menstrual migraines usually last longer than non-menstrual migraines and are often much more difficult to treat effectively.

Women suffer from migraines far more frequently than men. In fact, in adult women the rate of frequency is roughly 15% to 17%, whereas in men it is only about 5%. Menstrual migraines are a significant contributing factor.

25% to 30% of all women in their 30s experience at least an occasional menstrual migraine.

Studies have shown that estrogen withdrawal is a key factor in migraines associated with menstrual cycles.

60% to 70% of women who suffer from migraines have menstrual-related migraines.

10% to 14% of women with migraines have them only during menstruation. These types of headaches are known as ‘true menstrual migraines’.

Premenstrual migraine may in fact be part premenstrual syndrome (PMS), the menstrual related mood disorder. Symptoms of PMS include irritability and/or depression, fatigue, bloating and, yes, headache.

Two-thirds of women who suffer from pre-menopausal migraines find their condition improve with physiologic menopause. On the other hand, research has shown that surgical menopause worsens migraine conditions in two-thirds of cases.

Migraine attacks usually disappear during pregnancy. At the same time, however, some women report an initial onset of migraines during the first trimester of pregnancy. Migraine headaches disappear after the third month of pregnancy.

Treatment options for menstrual migraines

When choosing to treat menstrual migraines with medication, the drugs used most often are non-steroidal anti-inflammatory medications (NSAIDs).

The NSAIDS of choice in treating menstrual migraines are:

ibuprofen (Advil and Motrin)
nabumetone (Relafen)
ketoprofen (Orudis)
fenoprofen calcium (Nalfon)
naproxen (Naprosyn)

For best results when using NSAIDs to treat migraines, usage should be started two to three days before menstrual flow actually begins and the therapy should be continued throughout the period. Gastrointestinal side effects are generally not serious enough to be considered because the therapy takes place over such a short period, no pun intended.

Doctors also recommend taking NSAIDs for patients who suffer from more severe menstrual migraines or who desire to continue taking oral contraceptives. This therapy should begin the l9th day of your cycle and continue through the second day of the next cycle.

Some women have found antinausea medicine and pain relievers like aspirin, ibuprofen or acetaminophen sufficient enough to dull the pain. Others trust in analgesics or serotonin agonists such as Imitrex, Zomig, Amerge or Maxalt. It is extremely important to be aware of and avoid the dangers of a repetitive pattern of medication or overuse of medication as this can cause a rebound headache.

Other treatments for menstrual migraines

A treatment that is utilized in the days leading up to your period and may either delay or actually prevent the onset of a menstrual migraine is an estrogen skin patch.

Research has shown that daily doses of magnesium may help menstrual migraines in certain women. In addition, vitamin and herbal treatments have been found to be quite effective. The herb feverfew or vitamin B2 when taken on a daily basis may reduce either the severity or the frequency of headaches, though research does not point to menstrual migraines in particular.

Even though two-thirds of women do report improvement in their migraine condition with the onset of natural menopause, two-thirds of women report a worsening with surgery, therefore neither a hysterectomy nor an ovarian removal are recommended as a possible remedy.

As always, you must consult your physician for a proper diagnosis before discontinuing or starting any kind of new treatment, including over-the-counter medication treatments. Every one has a unique health profile that includes aspects specific to their physiology and family history that may preclude them from taking certain medications.

Some final tips for dealing with menstrual migraines

Managing your migraines is as important as managing your life. There are enough different migraine triggers to fill a book and keeping track of them can be a full time job.

It is highly recommended that you keep a journal or a ‘trigger diary’ that includes a record of foods you eat, weather conditions, medications you have taken, stressful events, menstrual activity, etc.

Also of benefit is developing a plan around your period. Reduce stress as much as possible by planning work and leisure commitments around your cycle so as to cut back on menstrual-related triggers as much as possible.