Why do I get really bad headaches during my period?
If your head starts throbbing around the first day of your period, it’s probably more than just a headache: It’s a menstrual migraine. And the short answer to this question is hormones. As estrogen drops in the days leading up to a menstrual period, a woman’s risk for migraine rises. This could be because estrogen helps activate parts of the brain that regulate the brains' perception of pain. The lower the estrogen, the fewer resources the brain has to mute the pain.
Of the four in ten women who experience a migraine in their lifetimes, more than 50 percent say that migraines and menstruation go hand in hand. Research shows that migraine risk rises 25 percent in the five days leading up to the first day of a period, and that risk increases to 71 percent within two days before the period starts. The risk of migraine is highest on the first day of a period and two days afterward.
There are a few ways to both treat and prevent headaches during your period, but they depend on what kind of menstrual migraines you get, says Dr. Rashmi Halker, an assistant professor of neurology at the Mayo Clinic Arizona and a fellow at the American Headache Society.
The first step is to establish a pattern by keeping a diary of when your period starts and when your migraines usually start. If you have very predictable periods and migraines, you can actually work with your doctor to prevent the pain by taking medicine ahead of time, Halker says. And even if you don’t find a consistent pattern of migraines related to menstruation, having data on how often migraines occur could show both you and your doctor that the problem is serious and perhaps requires prescription medication. It can also reveal whether or not certain medications are effective at treating migraines.
"If a woman has very predictable, regular cycles and she has a very predictable headache that comes on with her menstrual cycle, sometimes we use a ‘mini-prevention' around that vulnerable period,” Halker explains. "If her cycles are irregular, kind of sporadic, then you’d treat it like any other migraine."
Below are some of the ways you can typically prevent or treat menstrual migraines.
If you can predict your migraines…
Work with your doctor to come up with a ‘mini-prevention’ protocol.
Let’s say a woman has regular periods every 28 days, and she knows that the day before her period begins, her headache starts. Her doctor might advise her to take an over-the-counter medication like Aleve or a class of prescription medications for migraines, called triptans, two days before her period starts, Halker says.
“If she takes it right then, it can help her avoid that headache completely,” Halker said.
Consider skipping the sugar pills.
If you’re already taking birth control, the steady schedule of hormones (and hormone dips) make migraines even easier to predict and prevent. Women who take birth control pills might ask their doctor if they can skip over the sugar pill week and start straight into a new pack, which means they’ll skip their period completely and keep their estrogen levels elevated. In the same way, extended-cycle pills like Seasonale, which causes you to only have your period once every three months, could help as well, says Halker.
Other birth control-related therapies could involve taking pills with lower levels of estrogen, so that the hormone drop during the menstrual period isn’t as steep, or a progestin-only pill, notes the MayoClinic.
Use estrogen supplements.
They come in patch form or gel form, and a doctor has to prescribe them. However, Halker notes these supplements aren’t as effective as most medications and consequently aren’t usually the first line of defense when it comes to migraines.
"There’s some evidence that using the gel around the menstrual cycle can be helpful,” she said. “It’s a bit weaker in evidence compared to using a mini-prevention with something like Frova, which is a long-acting triptan, but some people do that."
If you can’t predict your migraines...
Avoid migraine triggers in general in the days leading up to your period.
Don’t skip meals or fast, and avoid processed foods, artificial sweeteners, alcohol and highly caffeinated drinks, notes the Mayo Clinic. Keep your sleep patterns as normal as possible, and try to either avoid stress or learn how to cope with it.
You can also be proactive about preventing migraines in general by asking about certain vitamin supplements, like magnesium.
Take the same medications you’d take for normal migraines.
Over-the-counter drugs like Excedrin Migraine, a combination of aspirin, acetaminophen and caffeine, can help, as well as nonsteroidal anti-inflammatory pain relief drugs like Aspirin, Aleve and Ibuprofen.
Your doctor can also prescribe triptans, which are drugs that reduce inflammation by restricting blood vessels. They work as well or better than over-the-counter meds, but because of their effect on blood vessels they can’t be used by people with coronary heart disease, a risk of stroke or uncontrolled high blood pressure.
You can prevent migraines completely, and you can stop head pain from developing into a full-blown migraine, Halker says. All it takes is a little bit of record keeping and some coordination with a doctor to see which protocols work best for you.