What is a Menstrual Migraine?

Migraines which result from the hormonal fluctuation associated with menstruation are known as menstrual migraines. Menstrual migraines, also known as hormonal migraines, are linked to the temporary decrease in hormone levels that accompany the onset of a woman's menstrual cycle. Treatment for a menstrual migraine usually involves the use of nonsteroidal anti-inflammatory (NSAID) medications, although other prescription medications may also be utilized.

Research has demonstrated that there is a direct correlation between the development of migraine headaches and a woman's menstrual cycle. Prior to the onset of monthly menstruation, a woman's estrogen levels diminish considerably, offsetting the natural balance between estrogen and progesterone levels. The disruption of hormone levels triggered by decreased estrogen adversely affects brain activity, which leads to the onset of a hormonal migraine.

Unlike traditional migraines, menstrual migraines are typically not prefaced by any visual disturbances, known as auras. The hormonal migraine may vary in intensity, with the pain localized to either the back of the neck and head or behind the eyes. The migraine usually occurs in the same location with each episode and involves feelings of pounding or throbbing. The duration of the migraine may vary and last as little as a few hours to as long as several days.

A woman who develops a menstrual migraine may experience a variety of symptoms. Feelings of sensitivity to visual and auditory stimuli or a feeling of tingling or numbness may indicate the onset of a menstrual migraine. A hormonal migraine may also induce symptoms that include a loss of appetite, fatigue, and sweating. Once the migraine has subsided, residual effects can linger and may include neck discomfort and a lack of mental clarity.

Due to their predictability, menstrual migraines are usually easy to diagnose and treat. During an office visit, a physician will generally ask a series of questions to determine when symptoms occur, possible symptom triggers, and family history. A physical examination may be conducted to rule out the existence of a secondary condition and verify a diagnosis of hormonal migraine. There are no diagnostic tests that may be administered to confirm the occurrence of a menstrual migraine.

Treatment for menstrual migraines generally involves the use of NSAID pain relievers or, in some cases, prescription medications. It is commonly recommended that women with menstrual migraines take an NSAID medication at least three days prior to their menstrual period and continue NSAID use through to the end of the month's cycle. In addition to the use of a NSAID medication, individuals experiencing a hormonal migraine should increase their water intake to prevent dehydration, avoid additional triggers, and get sufficient rest.

Women who experience severe, menstrual migraines may be prescribed medications that include anticonvulsants, beta-blockers, and calcium channel blockers. These drugs aid with alleviating the increased stress placed on the heart and blood pressure that occurs during migraine development and work to help prevent migraine onset. Prescription medications are employed to reduce migraine intensity and occurrence and should be taken as directed. The use of diuretics and limiting salt intake are also recommended to prevent hormonal migraine onset.

Prescription treatment is discouraged during pregnancy due to the adverse effects such drugs may have on the fetus. Pregnant women experiencing a hormonal migraine during their first trimester may be given a mild, over-the-counter pain reliever to ease discomfort. Postmenopausal women who experience hormonal migraines due to an estrogen imbalance may be prescribed an estrogen patch, which, when used correctly, will stabilize estrogen levels and prevent migraine occurrence. Complications associated with a menstrual migraine may include stroke and side effects associated with prescription medication use.