This is Real Women, Real Bodies: Your destination for trusted health and wellness advice, reflecting the untold experiences of people like you. This month, we're answering your burning hormonal health questions.
Your period isn’t just a metaphorical headache; the hormonal changes it kicks into effect each month can bring on literal — throbbing, aching — head pain.
“Migraines are one of the most common disabling conditions in reproductive-age women, and menstruation may be one of the biggest triggers,” says Arianna Sholes-Douglas, M.D., author of The Menopause Myth. In fact, nearly 60 percent of women who experience migraines report a link between their migraines and their period, according to a 2015 study published in the Journal of Headache Pain.
While standard headaches can be a side effect of your period (read: you may just be dehydrated), menstrual migraines are tied to your hormone levels and fall into two categories. “True menstrual migraines occur two days before to two days after the first day of menstrual bleeding,” explains Vincent Martin, M.D., professor at the University of Cincinnati College of Medicine and director of Headache and Facial Pain Center at the UC Gardner Neuroscience Institute. Only about seven to 19 percent of women who get migraines experience these.
The second, more common subtype — affecting 35 to 55 percent of women who get migraines — is a menstrually-related migraine, which can come on at other times during your cycle in addition to the onset of bleeding, says Susan Hutchinson, Ph.D., director of the Orange County Migraine and Headache Center in Irvine, CA.
Either way, these menstrual migraines (colloquially referred to as "period headaches") tend to last longer than typical migraines and are less responsive to migraine meds, Martin says.
Why do menstrual migraines happen?
Your period causes a whole host of hormonal changes in your body, and according to Hutchinson, the primary reason hormonal headaches occur is a drop or change in the estradiol level — the level of the main form of estrogen in your body.
To understand what’s happening there, you have to understand the basics of menstruation (hello, high school sex ed): Your estrogen peaks and your body starts making progesterone when you ovulate, or release an egg from your ovary; when that egg goes unfertilized (i.e. you don’t get pregnant), your body slams the brakes on producing estrogen and progesterone, which cues up your period.
What does that have to do with your brain? Well, “estrogen affects many chemical mediators in the brain,” explains Dr. Sholes-Doulgas. When your estrogen levels drop, it doesn’t just affect your reproductive organs. “These mediators are responsible for the vasodilation, vasoconstriction, and inflammation of the brain's blood supply. The vasodilation [or widening of blood vessels] is what is thought to cause migraines, but there’s still some controversy on the exact causes.” Estrogen also controls chemicals in the brain that affect how pain is perceived, and research has shown that when your estrogen is low, you’re more sensitive to pain—which could be why a migraine during your period feels so much worse than normal.
Are there any risks associated with menstrual migraines?
Migraines — whether menstrual or not — predispose a woman to stroke, says Martin. That’s especially true if you experience an aura (sensory changes like flashes of light, blind spots, other vision changes, or tingling in your hands or face) with your migraine.
Hormonal therapy like estrogen supplementation, which can typically be helpful for managing menstrual migraines, is not the way to go if you experience an aura with your migraines — “hormones can increase the risk of blood clots and can therefore increase the risk of stroke,” says Martin.
Instead, you can take non-hormonal medications or try non-medical therapy like meditation, acupuncture, massage, ice packs, low lighting and a quiet environment, increased hydration, and adequate rest and sleep.
Are you suffering from menstrual migraines?
As far as symptoms go, menstrual migraines aren’t that different from regular migraines. So the best thing to do if you suspect your period is to blame is to track your headaches, says Hutchinson; note when they occur, how long they last, and what the symptoms are. Beyond your iCal, apps like Clue and Flo can help you keep track of all the symptoms surrounding your period, or go old-school with a journal.
Even if your headaches are clearly linked to your period, “you should have the diagnosis confirmed by a healthcare provider,” she says. If your doc does diagnose your period headaches as migraines, the good news is that there's plenty you can do to manage them. Because even if you can’t control your hormones and how they affect your brain, that doesn't mean you have to just suck it up and deal with the effects.