Ah, menstruation—giver of stained underwear, unrelenting cramps, and for some people, migraine attacks. If you feel a vice-grip around your skull right around the time your uterus decides it’s time for a deep cleaning, it’s probably not a coincidence.
“Menstruation is a very common trigger of migraine attacks in women,” Addie Peretz, MD, clinical assistant professor in the department of neurology and neurological sciences at Stanford University School of Medicine, tells SELF. Migraine is a complex neurological condition that essentially makes your brain really sensitive to certain triggers, which can lead to painful (and potentially debilitating) attacks. For some people, migraine triggers include certain foods, a lack of sleep, or stress. For others, the drop in estrogen that occurs right before their period starts can bring on an attack, she says.
If you have menstrual migraine attacks, you already know they really suck. “Migraine attacks associated with menstruation tend to last longer, be more disabling, and are less treatment-responsive than non-menstrual migraine attacks,” Dr. Peretz says.
So, what can you do about it? Menstrual migraine treatment can be broken up into three general buckets: acute treatment, for when you’ve already got a migraine and are trying to get relief; mini preventive treatment, which focuses on preventing a migraine in the days before your cycle; and continuous preventive treatment, which might be appropriate if you have attacks at other points during the month or if your migraines aren’t responding to mini prevention.
“The overall goal is to decrease the intensity and the frequency of the migraine attacks so they have as little impact on your day-to-day functioning as possible. That’s a universal goal of migraine treatment, but especially true during the menstrual cycle,” Mason Dyess, DO, a neurologist and headache medicine specialist at Ochsner Medical Center in New Orleans, tells SELF.
Ready to get some relief? Here’s what you can do—because PMS is already bad enough on its own.
Track your menstrual cycle and your migraine symptoms.
It’s important to figure out exactly when in your cycle you’re experiencing migraine attacks, how bad they tend to be, and whether they’re also happening outside of your period week. “Being able to pick up on patterns about when your migraine attacks are happening most often during the month is extremely powerful for headache providers,” Dr. Dyess says. “That can help us get a treatment strategy together that’s uniquely crafted to you and your triggers.”
Consider tracking your menstrual cycle and headache cycle, whether that’s with a physical calendar, a period app, or the Notes app on your phone. The sky’s the limit for how much information you can record, but there are a few key things to cover. “At a minimum, I would suggest tracking whether you had a headache each day, the severity of the pain, whether you took medication to alleviate your pain, and when your period started and ended,” Dr. Peretz says. This can help you and your doctor confirm if attacks coincide with typical hormone dips during your monthly cycle.
If you need contraception, some birth control can help reduce menstrual migraine symptoms.
Since a change in estrogen levels can trigger a migraine attack, one strategy is to try to minimize that hormonal dip. If this is the case for you, the pill, vaginal ring, patch, and other hormonal contraceptives may help change your migraine patterns. “Some patients go on birth control to make their menstrual cycles more predictable, or to eliminate them, which can sometimes reduce overall migraine burden,” Dr. Dyess explains.