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Period Migraine Means More Than a Monthly Headache—Here’s How to Deal

Acetaminophen is no match for menstrual migraine attacks.

Period headaches are one thing. Period migraine is another. If your period headaches are less of an intense allover throb and more of a one-sided, pulsating nightmare—possibly accompanied by nausea, vomiting, dizziness, chills, extreme fatigue, or sensitivity to light and sound—you probably already know you’re dealing with period migraine, or menstrual migraine, as medical professionals usually call it.

Signs and Symptoms of Period Migraine

The word migraine itself encompasses much more than “bad headache”; it refers to a chronic neurological condition with often-debilitating symptoms. As the name implies, menstrual migraine is a specific type of migraine that shows up before, during, or right after your period (or while you’re ovulating). The symptoms, which tend to be even more severe than those associated with other types of migraine, can last from a few hours up to several days. The cause will be unsurprising to anyone who’s ever experienced a period: As a female, you’re riding a constant hormone roller coaster. As levels of estrogen and progesterone soar and dip before and after your menstrual periods, these changes can trigger migraine headaches. As if cramps and the physical challenges of pregnancy and childbirth weren’t enough, women are also two to three times more likely than men to experience migraine, precisely because hormonal changes are major triggers for migraine attacks. The stats are kind of shocking: Migraine affects about one in three women over a lifetime, according to the American Migraine Foundation, and 60 to 70 percent of them experience menstrual migraine symptoms.

Another key variable in the menstrual migraine equation is contraceptive use, especially since migraine attacks peak for many women during their 30s, prime childbearing years. While contraceptives can help some women manage menstrual migraine, they can exacerbate symptoms for others. Combination birth control pills may bring on menstrual migraine symptoms due to the sharp drop in estrogen that occurs on inactive pill days. Thus, your doctor may recommend that you skip the placebo pills, and/or switch to a monophasic pill, which keeps hormone levels consistent across all active pills in the pack (and therefore more consistent throughout your menstrual cycle). Another option to ask about if you’ve noticed that your birth control intensifies or causes menstrual migraine: Contraceptives that use only the hormone progestin, like the mini-pill or certain IUDs, injections, and implants. On the other hand, women who frequently experience headaches right before their period thanks to that drop in estrogen levels may find relief by using oral contraceptives that keep estrogen levels more balanced throughout the month. Talk to your healthcare provider about your best options, and keep in mind that many women find that their migraine attacks stabilize after a few months of letting their bodies adjust to a new birth control method. Similar to contraceptives, hormone replacement therapy during menopause can have either a positive or negative effect when it comes to migraine pain, so it’s important to talk through all of your options with a knowledgeable healthcare provider, who may recommend using medication with a lower and/or more continuous dose of estradiol (a synthetic version of estrogen).

Treatment for Period Migraine

Unlike with typical period headaches or even mild migraine headaches, over-the-counter acetaminophen is often no match for menstrual migraine attacks. The first strategy to incorporate if you have menstrual migraine is prophylaxis, a medical term that refers to preventative treatment—in other words, don’t wait until your time of the month arrives. One common treatment option is to take an over-the-counter NSAID (non-steroidal anti-inflammatory drug) like ibuprofen or naproxen a few days before menstruation and then continue it throughout your period to fend off hormonal headaches. Daily oral magnesium supplements (400 to 600 mg) have also been shown to be a safe and effective in treating menstrually related migraine, especially pms-related attacks. If these strategies aren’t enough, another common strategy for preventative treatment involves taking a beta blocke. Originally introduced to treat high blood pressure, many beta blockers are now FDA-approved specifically as preventative medications for migraine treatment and can be useful for menstrual migraines in particular. When headache pain does kick in, take a prescription acute treatment like triptans within 15 minutes to manage the pain, and remember that like your period, this too shall pass—even when it seems like it’ll last forever.

Petra Guglielmetti is a health, wellness, and beauty journalist who taps into a broad network of doctors, scientists, and medical experts to write in-depth service articles for leading publications like Glamour, Health, Real Simple, and Parents.

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