Menstrual MigraineDr. Steve Wenrich
Migraine is a significant public health issue in the United States. 9.7% of men and 20.7% of women in the US report having a migraine or severe headache within the past 3 months . Before puberty, boys are more affected by migraine than girls, but with adolescence, both frequency and severity increase for migraines in girls. After menopause, migraine symptoms in women frequently improve.
Hormonally mediated migraines in reproductive age females are known as “menstrual migraines”. They typically occur just before or during menstruation and are probably caused by the normal drop in estrogen levels that occurs at this time. Note that it is not the estrogen that is causing the headache, rather it’s the change in estrogen levels that triggers the headache. The precise reason for this relationship is unclear, but is thought to involve estrogen’s effects on the vascular system.
Menstrual migraines may be treated using similar methods as other migraines, such as:
- Migraine treatment medications (triptans, pain relievers, ergotamines, etc)
- Migraine treatment procedures (SPG, Occipital Nerve Blocks, Botox)
- Migraine preventative medications (topiramate, magnesium, amitriptyline, erenumab-aooe, etc)
- Dietary changes
- Sleep hygiene
- Lifestyle changes
In addition, many menstrual sufferers can benefit by controlling their estrogen swings using supplemental products such as oral or transdermal birth control, oral or transdermal conjugated estrogen, or some other estrogen supplementation.
During pregnancy, estrogen levels rise rapidly and remain high throughout the pregnancy. Many women with menstrual migraines will improve during the pregnancy because of a lack in fluctuation of estrogen levels.
Peri-menopause (the period of several years before menstruation stops) is often characterized by irregular and uneven rises and falls in estrogen levels. This can worsen menstrual migraine symptoms. Sometimes a transdermal estrogen patch can help to provide a low, steady estrogen dose to improve these symptoms.
Most women with menstrual migraines will improve after menopause (or after surgical removal of their ovaries, which may be done with a hysterectomy). If you suffer from menstrual migraines and are contemplating a hysterectomy for other reasons, discuss this with your physician. Generally, ovaries are NOT removed with a hysterectomy unless there is a particular reason for their removal. Menstrual migraines may be such a reason.
 QuickStats: Percentage of Adults Aged ≥18 Years Who Reported Having a Severe Headache or Migraine in the Past 3 Months, by Sex and Age Group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:654. DOI: http://dx.doi.org/10.15585/mmwr.mm6624a8
 Sacco, Simona, et al. “Migraine in Women: the Role of Hormones and Their Impact on Vascular Diseases.” Advances in Pediatrics., U.S. National Library of Medicine, Apr. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3311830/.