Menstrual Migraines

2 (4)Definition of Menstrual Migraine Menstrual migraine, as defined by the International Headache Society, has two subtypes. Attacks of menstrually related migraine without aura must have an onset during the peri-menstrual time period (2 days before to 3 days after the onset of menstruation) and this pattern must be confirmed in 2/3 of menstrual cycles, but other attacks may occur at other times of the menstrual cycle. Attacks of pure menstrual migraine without aura are similar to the above criteria except that migraine headaches are strictly limited to the peri-menstrual time period and do not occur at other times of the month. The prevalence of menstrually related migraine without aura ranges from 35-51% of females with migraine while that of pure menstrual migraine without aura varies from 7-19%. American Headache Society

The general cause of menstrual related migraines is the drop in estrogen.


There are some short term treatments specific to the cycle involved. NSAIDs, Triptans and estrogen transdermal patches. Naproxen sodium at 550mgs given 6 days before and 7 days after the period begins has been effective with menstrual migraines. Three types of triptans (frovatriptan, naratriptan and zolmiptriptan) gieven 4-5 days before has also proven effective but the correct dosage has to be used. One hundred micrigram transdermal estradiol patches were more effective than 25 to 50 mcg patches in a study.

Then there are hormonal treatments such as birth control options to go through. Be mindful, that migraine with aura cannot take estrogen based birth control. Pills with low doses of estrogen and those with progesterone  can cause fewer side effects and therefore trigger less migraines. In some cases, this treatment triggers migraines.


My issue has always been that I cannot take triptans more than a day in a row due to side effects. I cannot take NSAIDs at all. And I have migraine with aura so estrogen birth control is out. I tried depo shots and got severe vertigo for my troubles, I have vestibular migraines as well. Not sure why that was triggered but really didn’t like that idea at all.

For my this type of migraine starts three days before my cycle and continues for about five to six days into it. It is the most brutal of migraines. It is in fact one long acute continuous migraine that doesn’t respond to a thing. I miss the most amount of work from them. They used to be quite a bit worse because my cycle was longer. When it spontaneously got shorter, which I believe was due to the depo, I had less days for it to present itself so I suffer more like 3 days before and 2 to 3 in. Which is a real break for me on these.




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