Mastering Menstrual Migraines: Causes, Relief, and Prevention Strategies

Migraines are intense headaches that are often localized to one side of the head, and may be associated with nausea, sensitivity to light and sound, and a pulsing nature of the pain.

Migraines are complex; we don’t fully understand why they happen, what puts individuals at risk for them (genetics, stress, sleep, food, hormones) and truly what happens in the brain when they start. We do know they are many events that occur in the brain that unfold over the hours and days leading up to a migraine.

Menstrual Migraines

A common experience in many of our patients in the clinic is experiencing migraines that are associated with their menstrual cycle. To be considered a true menstrual migraine, the onset of the headache must occur on or within two days of a patients period. If this consistently occurs multiple cycles in a row, we consider it a menstrual migraine

Why do menstrual migraine occur?

The cause of a menstrual migraine is thought to be related to one of our sex hormones: estrogen. As our cycle progresses, estrogen slowly builds in concentration in our body, right before our period, our hormones drop. It was thought the menstrual migraine is triggered by the drop in estrogen right before our period begins, rather than the hormone itself (see image 1).

In order to confirm this, researchers conducted studies where they gave patients estrogen before their periods to see if they could prevent the drop in estrogen triggering a migraine - and they found it did. This confirmed the suspicion that the decrease in estrogen is what triggers the menstrual migraine.

Menstrual cycle hormones and related incidence of migraines. As estrogen drops (dark green line) close to menstrual cycle onset (cycle day 1) there is an increase in reported days of migraine (light green chart). There is also a decline in estrogen post ovulation (day -15 in chart) in which there is a small increase in migraine reports. Image source: Vetvik 2021

When am I most susceptible to menstrual migraines?

Since we understand menstrual migraine occur when estrogen is decreasing or dropping, it is in those moments of our menstrual cycle, and our lives when estrogen is decreasing we may experience menstrual migraines or an increase in menstrual migraines.

This means that often patients who are cycling naturally (no hormonal birth control) may experience migraines with the onset of their period, or at ovulation (part way through the month) where estrogen declines briefly post ovulation.

Perimenopause, the transitional time before we enter menopause is characterized by not only a decline in estrogen overall (which you guessed it, may contribute to an increase in migraines) but also a fluctuation in estrogen (meaning it is increasing and decreasing in an unpredictable way. Typically when estrogen levels settle and decrease (in menopause) hormonal related migraines subside.

We also see this when estrogen stabilizes in pregnancy: there is typically an improvement in hormonally related migraines during pregnancy, which unfortunately may return postpartum.

What can be done?

For menstrual related migraines estrogen “stabilizing” treatments are the most effective. These may look like leveraging hormonal birth control to control hormonal fluctuations, or utilizing estrogen patches pre-period to prevent the drop off before your period. Th

What about naturopathic medicine?

From a naturopathic perspective we can provide you support using lifestyle factors (diet, exercise, stress management) as well as specific foods and supplement recommendations, and acupuncture to support your hormonal and migraines overall. We can provide additional recommendations and treatments that focus on all areas of your health including education around all your treatment options.

Want to learn more? Book a complimentary meet and greet appointment with one of our naturopathic doctors to learn how we can help you with your migraines.