Types of Menstrual Migraines
There are two sub-types of menstrual migraines: pure menstrual migraines and menstrual-related migraines, with the latter being more common than the former.
Symptoms of a pure menstrual migraine include:
A migraine headache without aura that occurs exclusively during the one or two days before or after the onset of your period and occurs in more than 60% of your cycles
Symptoms of menstrual-related migraines include:
A migraine without aura that occurs one to two days before or after the onset of your period and occurs in more than 60% of your cycles Migraines with or without aura that also occur at other times in your cycle
The Role of Estrogen
Researchers have found a strong connection between estrogen and menstrual migraines. Typically, higher estrogen levels prevent migraines, whereas lower levels can trigger them. But it may also be that the fluctuation or change in estrogen levels triggers a migraine, not simply the fact that levels are low.
A woman’s estrogen levels drop to their lowest point right before menstruation, and this is usually the time that migraines are most likely to occur.
One theory is that the drop in estrogen right before menstruation excites the brain regions that are involved in a migraine, triggering an attack. This is supported by the fact that women with migraines tend to get more migraines in perimenopause—a period of time prior to menopause when a woman’s estrogen levels fluctuate.
Likewise, during the second and third trimester of pregnancy, many women obtain migraine relief, which is again attributed to the naturally high levels of estrogen in a woman’s body at that time.
How Birth Control Pills May Help
Menstrual migraines tend to be more severe and less responsive to the types of medications that are typically used to prevent or treat acute attacks that occur at other times of the month.
For some women, taking a continuous combination birth control pill—which consists of both estrogen and progestin—can reduce the frequency of attacks. These pills inhibit ovulation (which triggers the hormone change) and maintain estrogen levels by eliminating the hormone-free week associated with the cyclic use of the birth control pill.
With the continuous pill, you take the pills continuously to keep your estrogen levels constant. This means skipping the placebo pills if you have a 28-day pill pack, or taking a pill every day (no skipping needed) if you have a 21-day pill pack.
Another option is a progestin-only pill, also called the MiniPill. These pills prevent pregnancy by thickening the cervical mucus, making it much harder for sperm to swim through.
Progestin-only pills are prescribed for women who should not take pills containing estrogen, such as women who smoke, have high blood pressure, a history of blood clots, or migraine with aura during other times of the month. For women in this category, estrogen can increase the risk of stroke.
Birth control pills can also be used in combination with triptans and other medications typically prescribed for migraine. Avoiding migraine triggers, such as stress, lack of sleep, or irregular eating, is another useful prevention strategy.
A Word From Verywell
Every woman responds to hormones differently, and there are side effects and contraindications involved in using birth control pills that may make it an inappropriate treatment in some cases. Some women benefit from using birth control pills, some do not, and others may even experience worsening of their migraines.
Your healthcare provider may ask you to keep a diary of your attacks for several months, noting each time you experience a migraine and the dates of your menstrual flow. This can help her determine if you do, in fact, have menstrual migraines, and decide on the best treatment strategy going forward.
