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Menstrual Migranes

Donald Aulds, M.D.

Migraine headaches are one of the most severe forms of headaches but are not always the same for everyone. Women are more likely to have migraine headaches than men possibly due to hormone level fluctuations through the menstrual cycle. Menstrual migraines are associated with the menstrual cycle and usually occur immediately before the onset of menses. Migraines headaches have been associated with but may not always include the following symptoms:

  • Intense throbbing or dull aching pain usually on one side of the head (may sometimes be found on both sides)
  • Nausea and/or vomiting
  • Being bothered by light, noise and odors
  • Fatigue and/or confusion
  • Visual changes that may include blurred vision or spots before the eyes
  • Coldness and/or sweating

Researchers have found migraines seem to be caused by an inflammatory response in the blood vessels in the brain. This response can be triggered by many different factors such as:

  • Irregular and missed meals that cause a fluctuation in nutrients and sugar in the blood stream
  • Sleep patterns including too little and too much sleep
  • Certain noise, lights and odors
  • Stress and anxiety
  • Hormonal changes during the menstrual cycle
  • Alcohol especially red wine and some alcohol aged in certain types of wood barrels
  • Caffeine
  • Food products that may include soy products, certain cheeses and hot dogs
  • Artificial sweeteners

What causes menstrual migraines?
Research has not been able to completely identify the cause of the menstrual pattern to the headaches. Research does suggest that the rapid drop of progesterone just prior to the onset of the period may play a role in the inflammatory response in the blood vessels. Some women may see improvement or worsening of the headaches while on birth control pills. If a birth control pill is to be used, most women with menstrual migraines do better with a pill that has a steady level of hormones throughout the month than one that changes through the month. In women who are estrogen dominant, the headaches may be worse and when balanced with natural progesterone, improvement has been noted. Menstrual migraines may be more severe than regular migraines, may last longer and may be more resistant to standard medications. Since they usually occur with the period, work is being done to try to prevent the problem.

What can be done to try to prevent the menstrual migraines?
Certain lifestyle changes can help prevent migraine headaches:

  • Go to bed and wake up at regular times each day
  • Eat healthy regular meals
  • Exercise three to five days each week
  • Drink plenty of water
  • Limit caffeine and alcohol
  • Stress reduction recent studies reveal that relaxation techniques were able to reduce migraine headaches by as much as 50 percent in most of the participants in the study

How are the migraines treated?
Migraines cannot be cured, but they can be managed to reduce the severity and frequency. The approach that seems to be most successful is to use a product or approach as soon as the headache is starting and not wait until it is severe. Over the counter medications such as aspirin, naproxen, ibuprofen and acetaminophen have been helpful for many people when taken early. Another approach has been to use medication in the family of drugs called triptans, which work by trying to control chemicals in the brain. Individuals with uncontrolled blood pressure or certain heart diseases cannot use triptans. Antidepressants, beta-blockers and calcium channel blockers are approaches to prevent the onset of the headache. Hormonal balancing has been successful in some women. Hormonal testing would need to be done to try to determine which hormonal approach might be helpful.

If you think that you might have menstrual migraines, talk to your doctor and try to get a handle on the problem.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.