Top things to know:
The menstrual cycle has been linked to some types of headaches, specifically tension-type headaches and migraines
Women are more likely than men to get migraine headaches, which researchers think is due to the influence of the hormones related to the menstrual cycle
Treatment for menstrually-related headaches includes pain relief medication and hormonal therapy
How headaches are related to the menstrual cycle
There are many different types and causes of headaches, but only two that can be linked to the menstrual cycle.
This is a very common type of headache. These headaches are often felt on both sides of the head and have a mild or moderate pressing or tightening quality (1). Some people experience headaches similar to these around the time of their period (2). More research is needed about this type of headache and how it may be linked to the cycle.
Migraine is a disorder with characteristic headaches that can be debilitating. In the US, 17.6% of women and 5.7% of men report experiencing at least one migraine headache within the past year (3).
Migraine headaches are usually quite severe, often have a throbbing type quality, and are usually felt on one side of the head. Migraines can have additional side effects, including feelings of nausea, vomiting, aggravated by normal activity, and a sensitivity to light or sound (1). Some people who have migraine disorder may experience aura symptoms, such as visual or sensory symptoms, which occur before or during an attack, which can signal that a migraine headache is coming (1). Migraines can last up to three days (1).
Women are three times more likely to experience at least one migraine over a year than men (3), which researchers think is due to the influence of the hormones related to the menstrual cycle, specifically estrogen (4,5). Menstrual migraines are thought to be caused by a drop in hormones before the start of the period (4,5).
A small percentage of women get migraine headaches at the start of their period. These migraines often last longer and involve more nausea than migraines that happen at other times—and they usually do not have an aura (1). Migraines that occur only with the start of the period are called Pure menstrual migraines.
In Clue, you can also use custom tags to track migraine headaches or other symptoms.
Menstrually-related migraines and headaches
The menstrual cycle and related hormonal changes can affect people with migraine disorder. In a study of women referred to headache specialists, about 1 in 10 of the participants stated that their migraines started at the time of menarche (the first menstrual period) (6). This may not be true for all women or people with cycles, since this study was among women seeking care, but it does suggest that menstrual hormones can have an impact.
Other reproductive stages in life can also impact when migraines show up. In the same study as above, two thirds of people reported a decrease or disappearance of their migraines during pregnancy (6).
Some people also get mid-cycle headaches as well, which could be in relation to ovulation. In one study, about 16% of participants experienced primarily mid-cycle headaches, while half experienced headaches that followed their menstrual cycle (7).
Headaches can also sometimes be part of PMS (8).
This is only a small collection of medications available to treat headaches and migraines, and there are other therapeutic and preventative medications available. Speak to your healthcare provider about which option would be best for you.
Science-backed remedies for tension-headaches
NSAIDs and over the counter painkillers: NSAIDs (nonsteroidal anti-inflammatory drugs) are a class of painkillers and anti-inflammatory medications, many of which are available without a prescription in many countries. Ibuprofen and ketoprofen are more effective than placebo at providing a person with tension headaches (9). Acetaminophen (paracetamol), which often gets grouped together with NSAIDs, also has been demonstrated to provide similar pain relief (9).
Although the above medications are helpful, they might not be as helpful as people think. A meta-analysis of 3,094 people with tension headaches showed that taking a dose of ibuprofen only provides a small number of people with pain relief (23 out of 100 people) compared to taking a placebo (16 out of 100) (10).
Acupuncture: Acupuncture may offer some help in decreasing the frequency of tension headache occurrences when treated at the start of symptoms (11). More research is needed. Treatment with acupuncture for frequent migraines may offer some relief in decreasing the frequency of migraine attacks (12).
Science-backed remedies for menstrual migraine
Pain relief therapies
Triptans (including sumatripin): This is a type of medication used to treat both acute menstrual migraines, as well as migraines unrelated to the menstrual cycle (4,13). In order for the medication to work best, sumatripin should be taken promptly while pain levels are still mild. Don’t hold off on the medication and try to be a hero. This will only make the medication less likely to provide effective pain relief (13). You may need a prescription for this medication, so be sure to talk to your healthcare provider first.
Over the counter pain medication like naproxen (NSAID) and acetaminophen (paracetamol): While these therapies offer more pain relief than doing nothing, neither of these are reliable in terms of eliminating migraine pain (14,15). Consider asking your healthcare provider about triptans instead.
Preventative menstrual migraine treatments
Triptans: This medication can also be taken to prevent future migraines from happening. In one study, using triptans for a few days before the start of the period helped reduce both severity and frequency of menstrual migraine headaches (16).
Hormone stabilization techniques: Preventative treatment using hormone therapy may help to decrease the frequency of severe menstrual migraines. In one study, researchers looked at how two treatments with hormonal contraception affected migraines. The majority of participants (95%) were prescribed combined oral contraceptives (the pill) and additionally took estrogen during the week of their withdrawal bleed (“period”), which helped to make the drop in estrogen less severe. Fewer participants (5%) used the contraceptive patch during their normal menstrual period to prevent the drop in hormones. Among all participants, eight out of 10 people reported a decrease in their menstrual migraines and were able to reduce their pain-medication use by half (17).
Continuous birth control: Using a form of continuous/extended-use birth control may be an option to decrease menstrually related migraine attacks or headaches. People who took extended use combined oral contraceptives had fewer headache symptoms, and were more productive (18). Talk to your healthcare provider about extended use hormonal birth control, though this may not be the right therapy for everyone, especially those with migraine with aura—see the section below on hormonal birth control for more info.
Natural treatments and lifestyle adjustments for menstrual migraines
Lifestyle treatments are always tricky to study, since they are hard to control and not as well-funded as pharmaceutical medicine.
Magnesium: There’s some evidence that magnesium can relieve migraine pain (19). In a small preliminary trial, participants took magnesium supplements three times per day starting from Day 15 of their cycle until the start of their next period (20). This treatment helped decrease the participants’ total pain and also improved their PMS symptoms (20). In a randomized control trial where participants received either a placebo or a drug containing magnesium, vitamin B2, and coenzyme Q10, the severity of migraines was lower among those taking the drug, though the number of days in which migraines were experienced was not statistically different from the placebo (21).
Recommended lifestyle adjustments for migraines and headaches
Not all lifestyle changes are studied, but these recommendations are fairly standard for how to help you cope with your headaches. Give them a try, see what works best for you.
Get enough sleep: Since fatigue and sleep disturbances are linked to being migraine/headache triggers (1,22-24), be sure to adjust your bedtime accordingly so that you wake up relaxed and well rested. If you commonly have headaches in the morning after waking up, it may be a good idea to get checked for sleep apnea (1).
Reduce your stress levels: Stress, whether it’s particular events, feelings, or time periods, are linked to triggering migraines and headache (22-25). For this reason, stress management techniques like relaxation therapy, cognitive behavioural therapy, and biofeedback could help (25). It’s easier said than done, but prioritize de-stressing as best you can.
Avoid extreme weather: Weather changes, both hot and cold, can trigger migraines and headaches (22-24). Check the weather forecast and plan ahead. Be extra cautious about extreme heat and sun exposure, as exhaustion and dehydration can also cause headaches (26).
Find a dark and quiet space: For people experiencing a migraine headache, light and sound can aggravate migraine symptoms (1). Some people find relief by lying in dark, quiet rooms.
Migraine and hormonal birth control
Is your birth control causing headaches?
Headaches are sometimes a side effect of hormonal birth control (4). In one study, taking oral contraceptives affected migraines, with 24% of people experiencing increased frequency of migraines (6).
Estrogen-withdrawal headaches are a type of headache that people get during their “pill-free” or “sugar-pill week” when they are taking oral contraceptives. This type of headache usually goes away within 3 days, but then will return during the estrogen-free week of the next cycle (1).
Hormonal contraception for people with migraine
People with migraine with aura are not recommended to use combined hormonal contraceptives (like the pill, the ring, or the patch) (27). Having migraines with aura is a risk factor for experiencing a stroke (28-30), plus taking combined hormonal contraceptives up to doubles that risk (31,32). The combination of these risk factors is associated with a 3x increased risk of stroke, compared to people with migraine who don’t use combined hormonal contraceptives (27).
The United States Centers for Disease Control and Prevention (CDC) says people with chronic migraine are safe to use certain forms of contraception:
intrauterine device (IUD) (both hormonal or copper are fine)
the progestin-only shot
any form of emergency contraception (27)
Most people who experience migraine without aura can use combined hormonal contraceptives, too, as the risk of increased stroke is outweighed by the benefits that the pill offers (27); however, people with other risk factors for stroke, such as older age and cigarette smoking, may be advised not to use combined hormonal birth control (27).
People with non-migraine headaches do not have any restrictions on hormonal birth control (27).
Some birth control options may be safer than others, depending on your age and other risk factors (27). Speak to your healthcare provider to figure out what is the best contraceptive method for you.
Do you have migraine disorder or headaches, but are not sure if they are if are related to your cycle? Get tracking. You can use Clue to track your headaches, and even add custom tags. Do this consistently for a couple of cycles so that you and your healthcare provider can see if there is a pattern.
Download Clue to track your headaches and see how they appear in relation to your cycle.