Menstrual migraines

Migraine attacks that happen just before or during your period are called menstrual migraines. The NHS says they are often longer and more severe than attacks at other times. The Migraine Trust explains that a drop in oestrogen in the days before your period is a common trigger.

How common, and what makes it "menstrual"?

The Migraine Trust says as many as two-thirds of women with migraine may have attacks linked to their periods. In menstrual migraine the attacks come from about 2 days before your period to day 3, in at least 2 out of 3 periods. Most people with menstrual migraine also have attacks at other times. Fewer than 1 in 100 women with migraine only get them with their period. Menstrual attacks are more likely to be without aura, and can be harder to treat.

Spotting a pattern

There is no test, so a diary is the best tool. The Migraine Trust suggests recording migraines and period days for at least 3 months. Log headaches in Splash alongside your period: if they keep landing in the same few days, you can plan ahead with your doctor.

Treatment options a GP might discuss

• Standard migraine treatments: painkillers such as ibuprofen or paracetamol, taken as soon as the headache starts, plus anti-sickness medicine or triptans.
• For painful periods too: stronger anti-inflammatories like naproxen or mefenamic acid.
• A short course of a triptan taken on the days you expect an attack (often called mini-prevention).
• Preventive medicines, if attacks are frequent.
• Hormonal options, such as taking the combined pill without a break. This is not suitable if you have migraine with aura (see below).

What is aura?

Aura is a warning sign before a migraine, such as zigzag lines, flashing lights, pins and needles, or trouble speaking. The NHS says aura should not last longer than an hour.

Other common triggers

• Stress and tiredness.
• Skipping meals or not eating regularly.
• Too much caffeine.
• Not enough exercise.
• Not drinking enough, or disturbed sleep.
• Anxiety and low mood.