Menstrual Migraines: Why Headaches Follow Your Cycle

TL;DR: Menstrual migraine attacks happen between 2 days before and 3 days after your period starts, and they are often longer and more severe than other migraines. The drop in oestrogen before a period is thought to be the trigger. Track your headaches for at least two to three cycles to confirm the pattern. Painkillers taken early, triptans and, for some women, a short course of a triptan around your period can help. If you get migraine with aura, the combined pill is usually not recommended because of stroke risk. A sudden, severe headache is an emergency.

You know the one. It turns up a day or two before your period, settles behind one eye, and makes the light from your phone feel like a torch. Painkillers barely touch it, and it hangs around longer than any other headache you get. You might have been told it is stress, or that you should drink more water. If the timing is the same month after month, though, there is a good chance your cycle is part of the story. This is menstrual migraine, and it is common, disruptive to work and family life, and treatable.

What is menstrual migraine?

Menstrual migraine is migraine that is linked to your period. NICE, the body that sets clinical guidance in England, says to suspect menstrual-related migraine when attacks happen mainly between 2 days before and 3 days after your period starts, in at least 2 out of 3 cycles in a row. Some women only get migraine in this window. Others get migraine at other times of the month too, with their period-time attacks on top.

The NHS notes that attacks just before or during your period are often longer and more severe than at other times. An evidence review in the journal Neurology found period-related attacks also tend to respond less well to ordinary painkillers. A 2023 review in The Journal of Headache and Pain estimates menstrual migraine affects about 6% of women of reproductive age.

Why does my cycle cause headaches?

The leading explanation is oestrogen withdrawal. Oestrogen levels fall sharply in the days before your period, and this drop is thought to trigger attacks in people who are prone to migraine. Scottish NHS guidance describes the fall in oestrogen just before menstruation as a known trigger, and notes that migraine is more frequent, more severe and harder to treat around that time. Researchers are still working out exactly how oestrogen acts on the pain pathways involved, and the 2023 review calls for larger studies, but the timing link is well recognised.

This also explains why migraine patterns often shift at other hormonal turning points, such as pregnancy and perimenopause. If you want a refresher on what your hormones do through the month, our post on understanding your cycle walks through each phase.

How do I know if my headaches follow my cycle?

Track them. NICE recommends using a headache diary for at least 2 menstrual cycles to diagnose menstrual-related migraine, and its general advice is to record headaches for at least 8 weeks. Note:

• The day your period starts
• Each headache: date, time, how long it lasted and how bad it was
• Other symptoms, such as nausea, sensitivity to light or sound, or any aura
• Every medicine you took, including over-the-counter painkillers
• Possible triggers, such as missed meals, poor sleep or stress

After two or three cycles, lay the headache days over your period days. If most attacks cluster in that day -2 to day +3 window, you have something concrete to show your doctor. Our guide on how to track your period has simple ways to start, and if your pre-period days bring other dips in mood or energy, the luteal phase crash explains what is going on.

What treatments help menstrual migraine?

Treatment usually starts with the same options as other migraines, used well.

Painkillers taken early. The NHS advises taking painkillers such as ibuprofen or paracetamol as soon as the headache starts. Non-steroidal anti-inflammatory drugs (NSAIDs) have extra appeal around your period because they can also ease period pain. The Neurology review found evidence supporting mefenamic acid 500 mg, an NSAID often prescribed for period pain, for treating menstrual migraine attacks.

Triptans. These are prescription migraine medicines. NICE recommends combining an oral triptan with an NSAID or with paracetamol for acute migraine, depending on your preference and health history. Sumatriptan and rizatriptan both have evidence for period-related attacks.

Short-term prevention around your period. If your periods are regular and your attacks are predictable but do not respond well enough to standard treatment, NICE suggests a doctor may consider frovatriptan 2.5 mg twice a day, or zolmitriptan, on the days migraine is expected. This is sometimes called mini-prophylaxis. NICE notes that this is an off-label use of these medicines, so your prescriber will talk it through with you. Scottish guidance describes the usual window as 2 days before until 3 days after bleeding starts, and points out it only works if your cycle is regular enough to predict.

Watch for medication overuse headache. Taking painkillers too often can cause more headaches. The NHS advises not taking painkillers for more than 2 days a week where possible. If you already use triptans at other times of the month, adding a perimenstrual course increases this risk, so plan it with your doctor.

Hormonal approaches, such as using oestrogen around your period, are sometimes discussed by specialists. They are not suitable for everyone, which brings us to aura.

Can I take the combined pill if I get migraine with aura?

Usually not. Aura means warning symptoms before or during a migraine, such as flashing lights, zigzag lines, blind spots, pins and needles, or trouble speaking. NICE says aura symptoms develop gradually over at least 5 minutes and last 5 to 60 minutes.

If you have migraine with aura, NICE advises against routinely offering combined hormonal contraception, meaning the combined pill, patch or ring. The UK Medical Eligibility Criteria for contraceptive use rate combined hormonal contraception as category 4 for migraine with aura, which means an unacceptable health risk. The reason is stroke: migraine and the combined pill are each linked to stroke risk, and together the risk is higher. We explain this in stroke in women: the signs that get missed.

The good news is that the same UKMEC tables rate the copper IUD, hormonal IUD, implant, injection and progestogen-only pill as usable for women with migraine with aura. Our guide to contraception methods compared covers each. If you start getting aura for the first time while on the combined pill, speak to a doctor, nurse or pharmacist straight away about switching methods.

When is a headache an emergency?

Most headaches, including most migraines, are not dangerous. But some need help straight away. Call 999 or go to A&E (or your local emergency number) if, according to the NHS, your headache:

• Started suddenly and is extremely painful
• Comes with numbness or weakness in your face or body
• Makes it hard to speak, balance, walk or remember things
• Comes with drowsiness, confusion, vision loss or a seizure
• Comes with a high temperature, stiff neck, or a rash that does not fade when you press a glass on it
• Follows a head injury in the last 3 months

The NHS also says aura should not last longer than 1 hour, and that a migraine lasting more than 72 hours needs urgent care. Aura with weakness on one side, double vision, symptoms in only one eye or poor balance should be checked by a doctor, as NICE flags these as atypical. If you are pregnant and get a severe headache, seek urgent advice.

How Asele can help

A pattern is easier to spot when it is written down. Asele lets you track your cycle and log headaches and other symptoms day by day, so you can see whether your migraines line up with your period. Amara can help you make sense of your logs in Yoruba, Hausa, Igbo, Swahili, French or English. When you are ready to see a doctor, the Asele Health Brief turns your logs into a pre-visit summary, so you arrive with the headache and period record your doctor will want to see. You can find us at Asele.

This post is education, not medical advice. Speak to a doctor or pharmacist before starting or changing any migraine treatment or contraception.

References

1. NICE. Headaches in over 12s: diagnosis and management (CG150). nice.org.uk
2. NHS. Migraine. nhs.uk
3. NHS. Migraine: treatment. nhs.uk
4. NHS. Headaches. nhs.uk
5. Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology, 2008. pubmed.ncbi.nlm.nih.gov
6. Raffaelli B, et al. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. The Journal of Headache and Pain, 2023. pubmed.ncbi.nlm.nih.gov
7. NHS Scotland Right Decisions. Menstrual migraine. rightdecisions.scot.nhs.uk
8. College of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for Contraceptive Use, 2025 summary tables. cosrh.org
9. NHS. Period pain. nhs.uk