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Hormonal Migraine

Menstrual migraine usually occurs during the first day or days of menstruation.  This makes it different from most cyclic symptoms (see the PMS section) which tend to start during the week before the period, then get better when bleeding starts. Recent research into the effects of the main female hormone, estrogen, has helped us understand how the headaches are triggered. Estrogen is a vasodilator, which means that it keeps blood vessels open so they can better do their job of nurturing tissues and carrying away metabolic waste products. Menstrual bleeding begins when estrogen levels have fallen. This fall causes vessels in the brain to constrict followed by a rearrangement of blood flow, which results in inflammation and pain.

Menstrual migraine has a reputation among neurologists as being difficult to treat. Actually it can be easier to treat than some other forms because the headaches are somewhat predictable. Keeping a calendar is the first step. Then preventive medications can be started a day or two before the headache is expected and a long-acting triptan (more about this kind of medication below) can be taken during the first days of menstruation which is when the headache usually occurs.

Hormones clearly play a role in migraine. Commonly migraines are triggered by a certain phase of the cycle. The most common time is just before or at the beginning of menses. Estrogen levels are falling then, and this may be what sets off the headache. Some women’s migraines occur at a different phase of the cycle and some get the headaches without any apparent relationship to their cycle. Hormones can play a role in treating migraine but are usually not the first thing to try. Birth control pills help sometimes but for a few women make it worse. Sometimes adjusting the pill cycle can lessen the headaches.

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Migraine Headaches
Other Patterns of Headache
Hormonal Migraine
How Migraine is Treated
Alternative Treatments for Migraine


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