For many people with migraine, the feeling of a power drill twisting towards their brain is just part of the package. And while migraine attacks can include head pain, it’s not a headache. It’s actually considered a neurological disorder. An attack can involve a throbbing or pulsing pain on one side of the head and can be accompanied by nausea, vomiting, and sensitivity to light, sound, smell, and touch. It can last for hours, or days and the pain can be so intense that it interferes with your daily life.
The fact is many people who menstruate experience migraine attacks during that time of the month, and unsurprisingly, it has to do with hormones.
What is menstrually-related migraine, exactly?
If you notice that you get migraine attacks more frequently around your period—you’re probably right. In fact, between 60 and 70 percent of people assigned female at birth notice some connection between migraine attacks and menstruation.
This means that they experience migraine attacks anywhere between two days before their period to three days after the start of their period in addition to experiencing migraine attacks at other times of the cycle,” says Niushen Zhang, MD, FAHS, a board-certified neurologist and chief of the headache and facial pain division in the department of neurology at Stanford School of Medicine.
But if your symptoms only appear at that time of the month, it’s actually considered something different: menstrually-related migraine. Less than 10 to 20 percent of people assigned female at birth with migraine have menstrually-related migraine. “Menstrual migraine occurs in women who only experience migraine attacks around the time of menstruation—to be exact, it is on day one and two of menstruation—and do not experience migraine attacks at other times of the cycle,” Dr. Zhang says.
How do hormones play a role in migraine?
Estrogen is primarily thought to be the hormone responsible for migraine attacks, says Rohit Reddy, MD, a neurologist who specializes in headaches at Dartmouth Hitchcock Clinics in Concord, New Hampshire, and clinical assistant professor of Neurology at the Geisel School of Medicine, which is why migraine is more common in women. “This is due in large part to hormonal changes throughout a woman’s life. Menstruation is a common trigger and the drop in estrogen levels prior to period onset is what is responsible,” he says.
And while that is the leading theory on what’s going on, there is still a lot to learn about how estrogen and migraine are linked. “We don't completely understand why menses triggers migraine for many women,” Dr. Zhang says. “We think it's likely the fluctuations in estrogen levels associated with menses.”
That’s why it’s also difficult to say whether transgender folks taking estrogen may experience more migraine attacks, too. “It is not the estrogen itself, but the fluctuations with level drops that may trigger migraine,” Dr. Reddy says. Unfortunately, there is a lack of research on transgender people with migraine, but one study found that about 26% of transgender women who took hormone replacement therapy, including estrogen, experienced characteristics of migraine.
How to prevent migraine attacks triggered by your period
Preventing migraine attacks in general comes down to consistency, according to Dr. Zhang. “The migraine brain is hypersensitive to change, whether it’s changed in the rest of the body or in the surrounding environment. The most helpful thing we can do to prevent migraine attacks is to keep a consistent sleep, meal, and exercise schedule,” she says.
That means sticking to the same time bedtime each night (even on weekends), not skipping meals, and getting 20 minutes or so of daily aerobic activity, Dr. Zhang says.
Medications are also an option for all types of migraine. “There are a variety of hormonal and non-hormonal treatments available for preventive and acute treatment of menstrually-related migraine. There are risks and benefits with these treatments that require an in-depth discussion between the patient and their physician,” says Dr. Zhang.
The timing of medication is also key, says Dr. Reddy. “Patients can time medications prior to period onset—generally two days before—or take additional doses at that time with the guidance of their neurologist,” he says. “This is where keeping a headache diary becomes especially important—if a headache pattern emerges, we can try to break it by taking medications at the right time.”
If you are experiencing an uptick in migraine attacks around your period, it’s a good idea to talk with a trusted healthcare provider. They will help you figure out the best way to move forward—so you can spend more days feeling like yourself.
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