Why Do Some Women Get Period Headaches
Blame estrogen, says Sheeva Talebian, MD, a board-certified reproductive endocrinologist at CCRM in New York and a Womens Health advisory board member. Most menstrual-related headaches are due to the rapid drop in estrogen right before the onset of your period, she says.
A mini menstruation lesson: When you ovulate , your estrogen peaks and your ovary makes progesterone. For a while, your womanly hormones stay up. But if youre *not* pumping pregnancy hormones a week or so later, your body halts estrogen and progesterone production, triggering your period, Dr. Talebian explains.
That sudden drop in estrogen tweaks chemicals in your brain that affect how you experience pain, and up goes your sensitivity, the U.S. Department of Health & Human Services Office on Womens Health explains. Add to that constricted blood vessels, which happens to some women when theyre low in estrogen, et voilà: the dreaded period headache.
Other potential factors that can play into period headaches? Dehydration, blood loss , and poor sleep, Dr. Talebian notes. Already prone to migraines? Then theres a 60 percent chance youll suffer from menstrual migraines as well, per the National Headache Foundation . And if youre on birth control, that can bring on more headaches when you switch to your sugar pills and your estrogen levels tank .
Protect Your Sleep Stress And Hydration
There is always a stress factor at play when we see migraines and menses interacting. Lower the total perceived and experienced stress your body is experiencing by going through different areas of stress in your life and cutting your load. Get adequate rest so your body has time to repair. Hydration to ensure all the necessary minerals are absorbed into your tissues. With stress reduction, sleep, and hydration your body will begin to regulate itself and heal.
How To Prevent Menstrual Migraine Attacks
Theres nothing worse than knowing a debilitating migraine is headed your wayand with menstrual migraine, you can pretty much guarantee its going to hit at the same time each month. To stop one in its tracks, you need a two-pronged approach, per the American Migraine Foundation: mini-preventative treatment thats only used before and during your period, and continuous preventative treatment thats used all month.
Before and during your period, talk to your doctor about trying these preventative treatments:
- Take NSAIDs proactively: When taken twice daily during the five to seven days leading up to your period, NSAIDs like ibuprofen and naproxen can prevent or decrease the pain of menstrual migraine.
- Use estrogen supplements: Ask your doctor about supplementing with estrogen during the week of your period to prevent the estrogen dip that can trigger a migraine. This is easiest to do if youre already taking some sort of birth control.
- Try long-lasting triptans: Taking a long-acting triptan twice a day for four to five days during your period can prevent or decrease menstrual migraine. Ask your doctor before trying this method since taking triptans too frequently can lead to medication overuse headaches.
If the above strategies dont work, continuous preventative treatment might be your best bet:
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Whats A Migraine What Does It Feel Like
A migraine is more than a bad headache. Its a neurologic disease with a series of symptoms that might include debilitating pain on one side of your head that you may describe as pulsing or throbbing. Menstrual migraines, also known as hormone headaches, happen right before or during a womans period and may get worse with movement, light, smells, or sound. Your symptoms may last for a few hours, but theyll likely last days.
Its estimated that 70% of people who experience migraines are women. Of these women, 60% to 70% report a connection between their menstruation and their migraine attacks. Women experience migraine attacks three times more frequently than men.
A menstrual migraine is one of several types of migraine headaches. Examples of other migraines include migraine with aura, migraine without aura and chronic migraine.
Whats The Relationship Between Hormones And Headaches
Headaches in women, especially migraines, are related to changes in the levels of estrogen. Levels of estrogen drop immediately before the start of your menstrual flow .
Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, drop to their lowest levels.
Migraine attacks usually improve during pregnancy. However, some women have reported that their migraines started during the first trimester of pregnancy, and then went away.
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Can You Prevent These Headaches
There are a few methods your doctor might suggest.
Hormonal:Birth control pills or estrogen patches and vaginal rings may help lower the number of menstrual migraines you have or make them less severe. But they donât work for everyone. In some cases, they could make your migraines worse.
Your doctor might tell you to stay on birth control for 3 to 6 months without taking any placebo pills. This will prevent you from having a period and may stop your headaches.
If you get migraines with auras, using birth control that contains estrogen and progesterone isnât a safe option. Taking it could make you more likely to have a stroke. Other reasons your doctor may not want you to take birth control for your menstrual migraines:
- A history of smoking
Medicines that prevent migraines: If you donât respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You can take these regularly to make the headaches less severe or less frequent. These could include:
- Blood pressure medicines , and some antidepressants.
- CGRP inhibitors
Devices: Four devices may bring relief.
Talk To Your Doctor About Birth Control
For someone women, birth control can help with menstrual headaches. For other women, it can actually cause the headaches. A lot can depend on you, your individual migraine triggers, and the type of hormonal birth control you take, says ob/gyn and womens health expert Sherry Ross, M.D., at Santa Monica Women’s Health.
Some women suffer migraines just before their period due to a drop in estrogen levels, she explains. Women in that situation who are on a combination pill can actually be helped by birth control because it keeps estrogen levels steady throughout their cycle. Combination pills contain synthetic versions of the female hormones estrogen and progesterone.
For other women, the combination pills can make migraines worse and more frequent. Combination pills are generally not recommended for migraine sufferers because a) they can make migraines worse and b) they can put you at an increased risk of having a stroke, says Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at The University of Illinois College of Medicine at Chicago. Instead, doctors usually recommend a progestin pill or an IUD, she says.
If you suffer from migraines and suspect your period and/or birth control might be a factor, experts say its important to talk to your doctor. Together you can find a birth control method that works for youand keeps you headache-free.
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Migraines May Continue Beyond Menopause
Menopause most often happens after age 45, and it is also when the ovaries stop producing estrogen and progesterone. The gradual depletion of hormone levels not only causes infrequent periods, but it can also cause recurrent and longer-lasting migraines.
Vincent Martin, MD, professor and director of the Headache & Facial Pain Program at the University of Cincinnati College of Medicine, says that following menopause, “female hormones are falling and this can either drastically improve or sometimes worsen migraine attacks.”
What Are Really Bad Headaches Called
Migraine headaches are often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually happen one to four times a month. Along with the pain, people have other symptoms, such as sensitivity to light, noise, or smells nausea or vomiting loss of appetite and upset stomach or belly pain.
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Does This Feel Like Your Typical Headache Or
They may present a little differently than a typical headache or migraine. Menstrual headaches can range from mild to severe when it comes to pain, says Dr. Talebian, and they tend to start on one side of your head before spreading .
Classic migraine symptoms could strike, too for instance, you might feel super-sensitive to light and sick to your stomach.
What Triggers Migraines In Women
In addition to a drop in estrogen, birth control pills and hormone replacement therapy for menopause can change the frequency or severity of migraines. If you notice your migraine headache getting worse after starting one of these medications, it may be worthwhile to ask your healthcare provider for a medication that contains a lower dose of estrogen, or ask for a change from an interrupted dosing regimen to a continuous one.
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Daily Magnesium Has A Preventive Effect
I really like magnesium as a natural supplement to take every day to help prevent menstrual migraine, says Hindiyeh. There is evidence to support using magnesium, though the mechanism of action, or the why behind how it improves migraine, is not totally understood, she says. It could be stabilizing cells or decreasing hyperexcitability or neuronal firing, but thats all theoretical at this point, she adds.
You can learn more about the various types of magnesium supplements on the website Migraine Again, and remember that its always a good idea to talk with your doctor about any supplements you are taking or are interested in taking.
Deterrence And Patient Education
Patients who experience frequent or severe headaches may derive some benefit from a headache diary over a one month period where they can record the duration of each headache, the intensity and location, and whether it responded to therapy. Additionally, potential triggers such as food, alcohol, stressors, weather conditions, what day of their menstrual cycle they are on can be logged. This data may provide information for avoidances and may help to determine what triggers their migraine headaches and what makes them better.
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What Causes Period Migraines
A quick biology refresher for people with periods: Though most people only bleed for three to five days, your body goes through the menstrual cycle all month long. The levels of both estrogen and progesterone drop off sharply at the end of each monthly cycle, signaling to your body that its time to reset your cycle and begin your period. Dr. Lucky Sekhon, a New York City-based, board-certified OB-GYN and fertility specialist, tells Allure that migraines that show up two or three days before your period can be triggered by this steep hormone drop.
If you switched birth control and began to experience menstrual migraines shortly after, that switch may be the culprit. Its possible that a higher dose of estrogen in your birth control pills can make the hormone drop even steeper. Sometimes, all that is required to improve or prevent migraines is switching to a pill with a lower estrogen content, says Sekhon.
A 2013 literature review published in the Journal of Headache and Pain suggests that people who have migraines might even want to stick to progestin-only pills if they are going to use an oral contraceptive.
And menstrual migraines may be worse for people who are approaching menopause.
Hows A Menstrual Migraine Diagnosed What Tests Are Done
Your healthcare provider will want to establish a history of your migraine-related symptoms, likely asking you to:
- Describe the severity and location of your pain. Is the pain pounding? Pulsing? Throbbing?
- Tell how often you get migraine headaches.
- Remember if anything makes your headache better or worse.
- Discuss what medications you take to relieve the pain and how often you take them.
- Talk about the activities, foods, stressors, or the situations that may have brought on the migraine.
- Remember if anyone in your family gets migraine headaches.
- Tell how you felt before, during and after the headache.
Your healthcare provider may also order blood tests and imaging tests to make sure there are no other causes for your headache. An electroencephalogram may be ordered to rule out seizures.
Its helpful to both you and your healthcare provider if you keep a migraine journal. Take note of what symptoms you get, how long your symptoms last, and what makes your menstrual migraine better or worse. You and your healthcare provider may be able to use that information to help you heal, and possibly prevent or anticipate your migraine.
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What Are The Treatment Options For Menopausal Migraines
If you need to continue estrogen supplements after menopause, you should start on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, you may be told to take it every day. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch may be effective in stabilizing the levels of estrogen.
How To Prevent Or Treat Period Headaches
While theres no guarantee you can stop those pesky headaches around your period before they pop up, there are preventive measures you can take throughout the month that may help.
Brightens suggestion? Make a few simple diet and supplement tweaks. Magnesium-rich foods think leafy greens, nuts and avocados may help reduce the frequency or severity of headaches, she said.
Vora agreed with the magnesium tip, noting that when women have a magnesium deficiency, the symptoms around their period are a lot worse. The body has an increased need for magnesium related to the contraction of the uterus during menstruation, she said. This ends up pulling magnesium away from the rest of the body, which can create muscle tension. Tension in the muscles of the neck and the small muscles around the forehead, temples and scalp is a common contributor to headaches.
Vora also recommended getting some exercise. Her personal favorite? Pilates. Since headaches can come from muscle tension, she said, any exercise that strengthens the core and leads to better posture can help quite a bit.
And dont forget to work on reducing overall stress, she said, adding that some people consider acupuncture helpful. You can also try other stress-relief techniques like reading, going for a walk, talking to a friend or whatever works for you.
Sounds like prescriptions worth following.
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Why Menstrual Migraine Can Be Difficult
Menstrual migraine is one of the most difficult migraine conditions to manage for patients as well as for clinicians. Both require a good diary to understand how relevant it is and how much focus should be put on the hormones. It is often the ongoing small estrogen drops that are targeted but prostaglandin might further sensitize the head so these should also be considered to target.
Using estrogen is not a simple matter and is not always successful. We particularly avoid it in migraine with aura due to the risk of stroke. It requires careful consideration, usually with a headache specialist or a gynecologist with an interest in the area of menstrually related migraine and hormones.
Other Causes Of Migraine Attacks
Certain risk factors, such as age and family history, can play a role in whether you get migraine or menstrual migraine. Simply being a woman puts you at increased risk.
Of course, you cant control your sex, age, or family tree, but it may help to keep a migraine diary. This can help you identify and avoid triggers.
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How Is Menstrual Migraine Diagnosed
There are no tests available for menstrual migraine. The most accurate way to tell if you have menstrual migraine is to keep a diary for at least three months recording both your migraine attacks and the days you menstruate.
For menstrual migraine to be diagnosed migraine should occur predominately between two days before and up to three days into menstruation, in at least two out of three consecutive menstrual cycles.
Is Your Birth Control Causing Headaches
Headaches are sometimes a side effect of hormonal birth control . In one study, taking oral contraceptives affected migraines, with 24% of people experiencing increased frequency of migraines .
Estrogen-withdrawal headaches are a type of headache that people get during their âpill-freeâ or âsugar-pill weekâ when they are taking oral contraceptives. This type of headache usually goes away within 3 days, but then will return during the estrogen-free week of the next cycle .
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Is It Common To Get Migraines Before Your Period
I get migraines a few days before my period starts. Is it common to have migraines as part of PMS? Alaire*
Yes. Lots of women who have migraines get them as part of their PMS symptoms. Doctors believe that changing hormone levels are to blame for this type of headache, which is known as a menstrual migraine.
Take some steps to try to stop these headaches so you feel better. You could start by taking an over-the-counter medicine like ibuprofen to see if that works. If you often get headaches near your period, try taking the medicine for a few days around that time, even if your headaches haven’t started yet. Doing this might help you avoid getting a headache. Getting enough sleep, not skipping meals, exercising regularly, and managing stress are other ways to help prevent headaches.
If a headache does come on, sometimes a cool cloth or ice pack wrapped in a towel can help. You can also try lying down in a quiet, dark room.
If these things don’t work for you, or if your headaches are severe enough that you miss school or other activities, talk to your doctor. He or she may recommend a prescription medicine or refer you to a headache expert.
*Names have been changed to protect user privacy.