Menstrual Migraine

Menstrual Migraine


Migraine can have many various triggers. However, menses is arguably the most prevalent migraine trigger: migraine affects 3 times more women than men, and 60-70% of female migraineurs notice a menstrual association with their headaches.

Attacks of migraine during menses are called menstrual migraine. These attacks have been found to be less responsive to treatment, and are reported as more severe and disabling than headaches that are not associated with menses.

Additionally, women that have menstrual migraine are more likely to transform from episodic migraine to chronic migraine than women with migraine that isn’t menstrually related.

A decline of estrogen is believed to be the trigger of menstrually related migraine. This happens during the natural menstrual cycle, and also occurs during the placebo week for women taking birth control pills containing forms of estrogen.

New Approaches

Fortunately, new approaches and therapies have emerged in recent years for the management of menstrual migraine that resists conventional treatment. Short-term prophylactic therapies aimed at preventing menstrual migraine are initiated a few days before the start of the anticipated menstrual migraine.

The following examples have demonstrated effectiveness:

Naproxen sodium

550 mg twice daily, given several days before menses and continued throughout the menstrual cycle.


Frovatriptan (Frova), naratriptan (Amerge), or zolmiptripan (Zomig), administered two or three times a day during the peri-menstrual time period.

Additionally, a placebo-controlled double-blinded trial found that Vitamin E (400 IU daily, given as a short term prophylactic) was superior to placebo in decreasing pain severity and functional disability in women with menstrual migraine.


For women without contraindications, utilizing estrogen-containing hormonal contraception to avoid the decline in estrogen has also proven effective as a prophylactic therapy.

This can be accomplished with one of the combined oral contraceptives on the market that do not contain a placebo week, thereby maintaining a stable estrogen level and eliminating bleeding. Alternatively, choosing to omit the placebo week of pills can achieve the same goal. The continuous estrogen without a placebo week has also been effective with a vaginal ring known as NuvaRing. (Instead of replacing the Nuvaring every 4 weeks, the woman is instructed to change it every three weeks.)

For those women not taking birth control pills, transdermal estradiol patches used during the peri-menstrual period have also demonstrated efficacy in menstrual migraine prevention.


Menstrual migraine is a very real, and often very painful and disabling, condition that can even cause migraineurs to miss work, school, and other commitments.

Thankfully, multiple effective therapies are available that can prevent these migraine attacks. If you experience severe headache or migraine associated with your menstrual cycle, you do not have to continue to live in pain!

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