Menstrual migraine: understanding and relieving headaches related to menstruation

Studies show that menstrual migraines tend to be longer and more intense than migraines occurring outside the menstrual period, and they respond less well to conventional painkillers. Understanding this hormonal link and discussing it with your doctor allows you to consider strategies tailored to your profile and improve your menstrual comfort.

A migraine is considered a menstrual migraine when:

• An attack consistently appears within a window ranging from 2 days before to 3 days after the first day of your period;
• This recurs over at least two consecutive cycles (IHS criteria);
• It is predominantly a migraine without aura, although rare cases with aura have been described.

Migraines, whether menstrual or not, meet the same diagnostic criteria: unilateral, pulsating pain of moderate to severe intensity, aggravated by physical activity, accompanied by nausea and/or sensitivity to light and sound. The difference is therefore essentially circumstantial and hormonal.

The specific nature of menstrual migraine lies in:

• Its periodicity, which is strictly tied to the menstrual cycle;
• An often higher intensity, with attacks lasting an average of 24 hours compared to 12 hours outside this period (European study, 2021).

• The International Classification of Headache Disorders (ICHD-3) distinguishes two subtypes:
• Pure menstrual migraine (PMM): attacks occur exclusively in the perimenstrual window (between Day -2 and Day +3 of the cycle, where Day 1 corresponds to the first day of the period), and never at other times of the cycle. It affects about 10% of women who suffer from migraines.
• Menstrually-related migraine (MRM): attacks occur repeatedly around the time of the period, but can also happen at other times of the cycle. This is by far the most common form.

In both cases, the primary triggering mechanism remains the same: the drop in estrogen levels.

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It is not so much the absolute level of estrogen as the speed of its variation that triggers the attack. A 50% drop in estrogen levels within 24 hours can increase the excitability of the trigeminovascular system, which is responsible for 70% of pain sensations (Neuroscience Letters, 2020). Cases of estrogen dominance can also modulate this sensitivity and lead to increased intensity of attacks.

• Estrogens modulate serotonin: a drop promotes vascular dilation and meningeal inflammation.
• Prostaglandins, released during menstruation, increase nerve sensitivity and worsen pain.

The main mechanism identified is the sudden drop in estradiol levels (the most active form of estrogen) that occurs at the end of the luteal phase, just before the period. This rapid hormonal variation acts on several neurological and vascular systems:

• It influences the synthesis of serotonin, a key neurotransmitter in regulating pain and vasoconstriction. A drop in estrogen decreases the availability of serotonin, promoting cerebral vasodilation and thus migraine pain.
• It alters the sensitivity of the trigeminovascular system, the neural pathway involved in the generation of migraines.
• It promotes the synthesis of pro-inflammatory prostaglandins, particularly via uterine contractions—which explains the link between dysmenorrhea (painful periods) and menstrual migraines.

It is therefore not a low estrogen level in itself that causes the migraine, but rather the speed and magnitude of the drop—which explains why some women are more sensitive to it than others.

In a 28-day cycle (given as an indication, as every cycle is unique):

• • Day -2 to Day +3 (perimenstrual window): this is the primary at-risk period, during which estrogens plunge following the ovulatory peak. This is the timeframe defined by the ICHD-3 criteria.
• • Around ovulation (around Day 13-15): some women also suffer from a migraine during the post-ovulatory drop in estrogen, which is less documented but very real.

Outside of these windows, hormonal levels are relatively stable, which explains why attacks are less frequent in the middle of the cycle.

Hormonal fluctuation is the central factor, but several elements can lower the trigger threshold and worsen attacks:

• Chronic or acute stress (especially during the premenstrual phase, when stress tolerance is reduced)
• Sleep disruptions (insomnia, hypersomnia, changes in sleep rhythm)
• Dehydration and irregular meals (reactive hypoglycemia)
• Magnesium deficiency, which is common before periods and known to lower the migraine threshold
• Imbalances in the prostaglandin balance (omega-6/omega-3 ratio)
• Alcohol, foods rich in tyramine (aged cheeses, cured meats), caffeine

Menstrual migraines share the characteristics of classic migraines, with a few notable specificities:

• Pulsating pain, often on one side of the head (hemicrania), of moderate to severe intensity
• Worsening with physical effort, light (photophobia), and sound (phonophobia)
• Nausea, sometimes vomiting
• Occurrence within the Day -2 to Day +3 window repeatedly across at least 2 out of 3 cycles
• Longer attacks that are often less responsive to conventional painkillers than outside the menstrual period
• Frequent absence of aura (unlike some non-hormonal forms, menstrual migraine is usually without aura)
• Possible association with other premenstrual symptoms: intense fatigue, irritability, bloating, abdominal pain

A menstrual migraine attack typically lasts between 4 and 72 hours. However, it tends to be longer than migraines occurring outside the perimenstrual period. Attacks extending over 2 to 3 days are frequently reported, sometimes coinciding with the entire duration of the period.

This longer duration is explained by the persistence of the estrogen drop during the days of menstruation, maintaining the state of neurological vulnerability longer than a simple, one-time trigger.

The relationship between hormonal contraception and migraines is complex and highly individual. Here are the key points to know:

• The combined estrogen-progestin pill, by suppressing the natural fluctuations of the cycle, can reduce menstrual migraines, but the break week (placebo) itself causes a drop in estrogen that can trigger an attack.
• The progestin-only pill or the hormonal IUD (progestin only) can sometimes worsen migraines in some women, or have no effect at all.

Important: migraine with aura associated with a contraceptive containing synthetic estrogens is a subject that must be discussed with a doctor, due to a documented potential cardiovascular risk.

In all cases, any decision regarding contraception in the context of migraines must be made with a healthcare professional. Our products are not intended for medical use.

The diagnosis of menstrual migraine relies primarily on clinical observation and specifically on a migraine diary kept for at least 3 consecutive cycles. This is a simple, free, yet decisive tool.

For each day, note down:

• The presence or absence of a migraine attack (and its intensity)
• The start and end of your period (Day 1 = first day of bleeding)
• The medications taken and their effectiveness
• Potential triggers (stress, sleep, food, etc.)

If the attacks are regularly concentrated within the Day -2 to Day +3 window for at least 2 out of 3 cycles, the ICHD-3 diagnostic criteria are met. This diary is also the tool your doctor will use to refine their assessment.

Consult a doctor or a neurologist if:

• Your attacks last more than 48 hours or occur more than 4 times a month
• They are accompanied by an aura (visual disturbances, numbness, speech difficulties)
• Over-the-counter painkillers do not provide relief or require very frequent use (risk of medication overuse headaches)
• The migraine significantly impacts your quality of life, work, or activities
• You wish to explore medicinal prevention options tailored to your hormonal profile

Menstrual migraine is a real condition that deserves serious management and should not be minimized as "just period pain."

Several micronutrients and plants have been the subject of serious studies in the context of migraines or hormonal imbalance. They can provide complementary support but do not substitute for medical advice.

• Magnesium: this is the most documented micronutrient in migraine prevention. Clinical studies have shown that magnesium supplementation (especially in glycinate or bisglycinate forms) can reduce the frequency of attacks, particularly in women with menstrual migraines. Magnesium levels tend to drop before the period. (Mauskop A. et al., Headache 1995; Peikert A. et al., Cephalalgia 1996.)
• Vitamin B2 (riboflavin): supplementation at 400 mg/day has shown a significant reduction in migraine frequency in randomized controlled trials. Its action works by improving neuronal mitochondrial metabolism. (Schoenen J. et al., Neurology 1998.)
• Coenzyme Q10: involved in cellular energy production, it has been studied as a preventive agent for migraines with encouraging results in several clinical trials.
• Omega-3 (EPA/DHA): their anti-inflammatory effect can help modulate the production of pain-inducing prostaglandins. Several studies show their benefit in reducing migraine frequency and intensity.
• Saffron: recent studies suggest an effect on serotonin modulation and anxiety reduction, which are relevant factors in the premenstrual context.

These micronutritional approaches are part of a long-term and preventive approach: they do not relieve an acute attack, but over several weeks or months, they can contribute to reducing their frequency and intensity.

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A few lifestyle adjustments can significantly reduce vulnerability to attacks, especially in the days leading up to your period:

• Maintain stable sleep schedules (even on weekends)—irregular sleep is one of the primary triggers identified
• Eat smaller, more frequent meals to avoid reactive hypoglycemia, and stay regularly hydrated
• Reduce dietary triggers within the Day -5 to Day +3 window: alcohol, aged cheeses, cured meats (tyramine), ultra-processed foods
• Manage chronic stress with regular practices: cardiac coherence, yoga, mindfulness meditation (documented effectiveness in reducing migraine frequency)
• Keep a cycle log to anticipate the at-risk window and adapt your mental and physical workload accordingly
• Engage in moderate and regular sports activities outside of attack periods (intense effort during an attack can worsen symptoms)

At MiYé, we start from a simple conviction: the female body deserves answers tailored to its hormonal reality. That is why our formulations are designed to support hormonal balance globally by working on common micronutritional deficiencies, the inflammation pathway, and cycle regulation.

All of our formulations are free of phytohormones, free of suspected endocrine disruptors, and developed with active ingredients whose actions are documented. Because taking care of yourself should never be a gamble.

Pregnancy is one of the rare situations where many women with migraines notice a significant improvement or even a complete disappearance of attacks, especially from the 2nd trimester onward. The explanation is hormonal: during pregnancy, estrogen levels increase progressively and stably, without the cyclical fluctuations that usually trigger attacks.

In the 1st trimester, however, the still unstable hormonal variations can temporarily maintain or worsen migraines. After giving birth, the rapid drop in estrogen during the postpartum period can trigger a resurgence of attacks.

This observation confirms the central role of estrogen fluctuations, rather than an absolute hormone level, in triggering menstrual migraines.

Perimenopause (generally between ages 40 and 52) is often a period when hormonal migraines worsen. Cycles become irregular, estrogen fluctuations amplify and become less predictable, which multiplies the windows of vulnerability.

Short cycles follow long cycles, ovulation becomes erratic, and the body can experience several hormonal drops per month. For women who already suffered from menstrual migraines, this period is often described as particularly difficult.

At menopause (the permanent cessation of periods), hormones stabilize at a low level and most women notice a progressive improvement or even the disappearance of menstrual migraines. Menopause hormone therapy (MHT), when considered, must be discussed with a doctor, taking the migraine profile into account, especially in cases of a history of migraine with aura.

• Estrogens and migraine attacks with and without aura. Lancet Neurology.
• Estrogens, progestogens, and headache. Neurology.
• Characteristics of menstrual and nonmenstrual attacks in women with menstrually-related migraine. Cephalalgia.
• The International Classification of Headache Disorders. Cephalalgia.
• Intravenous magnesium sulfate relieves migraine attacks in patients with low serum ionized magnesium. Headache.
• Prophylaxis of migraine with oral magnesium: results from a prospective, multicenter, placebo-controlled and double-blind randomized study. Cephalalgia.
• Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology.