For many people, migraine attacks feel unpredictable. But for others, attacks follow a very clear pattern, consistently showing up on the days just before or during a menstrual period. These attacks are known as menstrual migraine attacks, and they can be especially intense and hard to manage.

This article explains what sets menstrual migraine apart from other migraine types and shares practical strategies that may help reduce the number or severity of migraine attacks during your cycle.

What’s a Menstrual Migraine?

A menstrual migraine is a migraine attack that happens around the time of your period. It’s believed that the main trigger of this type of migraine attack is the drop in estrogen that occurs in the days before menstruation begins.

Estrogen is a hormone that regulates the reproductive system and also affects chemicals in the brain involved in perceiving pain. Because of this, a drop in estrogen levels can increase your pain sensitivity and make headaches more likely.

When estrogen levels drop, serotonin levels may also fall. Serotonin is a key brain chemical involved in regulating pain, which may help explain why migraine attacks can happen around this time.

For the most part, menstrual migraine tends to happen in a predictable window, usually ranging from two days before your period starts to the first three days of bleeding.

When attacks happen only during this time frame in at least two out of three menstrual cycles, it’s considered pure menstrual migraine. If attacks happen at other times of the month too, it’s called menstrually related migraine.

Menstrually related migraine attacks are more common, which means they occur during this time frame and at other times of the month. Understanding the difference is important because it can affect whether a person may need treatment only during part of the month or throughout the month.

For some people, menstrual migraine attacks may be more severe and last longer than other types of migraine attacks. They may also be harder to treat and more likely to return within 24 hours if not treated early. However, because they often follow a pattern, you can often prepare for them in advance.

9 Tips for Period Migraine Relief

There’s no single solution for menstrual migraine, but there are many ways to reduce how often attacks happen and how intense they feel. The strategies below can be used on their own or together, and many people find that layering a few approaches gives them the most relief.

1. Track Your Menstrual Cycle and Migraine Patterns

Keeping track of when your migraine attacks happen is one of the most helpful steps you can take. Many people use a calendar, phone app, or diary to record period dates, symptoms, migraine attacks, and treatments. Tracking helps you see whether attacks cluster around the same time each month.

You should aim to track your menstrual migraine for at least three months to notice patterns.

2. Plan Ahead for High-Risk Days

Because menstrual migraine tends to happen on a more predictable schedule, you can prepare in advance. You may not feel like participating in your normal activities, so it may help to adjust your schedule as needed. On days you’re more likely to have menstrual migraine symptoms, try to get extra rest and keep stress levels down.

Your healthcare provider may also suggest medications to take preventively, before symptoms start. Using your three-month tracking record as a roadmap, you may be able to start “mini-prophylaxis,” which involves taking specific medications for only five to seven days to help prevent an attack before it gains momentum.

Sometimes, you’ll take medications daily. In other cases, you may need a higher dose as you get closer to menstruation. Preparing early for a migraine attack can help you feel less overwhelmed when symptoms hit.

3. Keep Sleep as Regular as Possible

Changes in your sleep patterns, such as staying up very late, oversleeping, or getting too little sleep, can trigger migraine attacks for many people, not just those with menstrual migraine.

Before your period, another hormone called progesterone rises. This hormone is responsible for preparing the body for pregnancy. If pregnancy doesn’t occur, progesterone levels drop quickly, leading to the start of menstruation. Progesterone has a relaxing effect, so when levels decrease dramatically, it can be hard to get a good night’s sleep.

While you can’t control shifts in your hormones, you can try to keep a consistent sleep schedule by:

• Going to bed and waking up at the same time each day
• Avoiding screens during the last hour before sleep
• Creating a calming bedtime routine and sleep environment

Even small improvements in sleep habits could help you get more rest and better manage migraine attacks.

4. Stay Hydrated Every Day of Your Cycle

Mild dehydration is a known migraine trigger for some people. During menstruation, blood loss and salt imbalances can make it easier to become dehydrated.

To help prevent dehydration, try to drink 2 liters of water throughout the day. Carrying a water bottle can help as a reminder. Foods that contain a lot of water, like strawberries, cucumbers, and oranges, can also help with hydration.

Staying hydrated won’t prevent every migraine attack, but for some people, drinking water may help ease symptoms.

5. Limit Migraine Triggers During Menstruation

Not everyone has the same triggers, but several foods have been commonly linked with migraine. During high-risk days, you may want to consider reducing other potential triggers such as:

• Caffeine
• Alcohol
• Spicy foods
• Artificial sweeteners
• Chocolate
• Dairy products
• Strong-smelling foods

Keep in mind that triggers are personal. If you believe a certain food is triggering your migraine symptoms, it’s best to avoid it as much as possible. Around the time of your period, when estrogen levels fall, it may be especially helpful to avoid other known personal migraine triggers.

6. Manage Stress Before It Builds Up

Stress is one of the most common migraine triggers overall. During the menstrual window, try to manage stress by practicing small stress-reducing habits like meditation, relaxation therapy, deep breathing, and exercise.

Deep-breathing exercises may help your body relax, which can be useful when stress starts to build. Taking a short break from overwhelming activities or setting aside at least 15 minutes each day for an activity you enjoy, like a hobby or meeting up with friends, can also help lower stress levels.

7. Eat Balanced Meals

Skipping meals or going long stretches without eating can increase the risk of migraine attacks. Eating scheduled, well-balanced meals during menstruation may help you manage menstrual migraine symptoms.

Opt for vegetables, fruits, and foods high in omega-3 fatty acids, like fish and many shellfish, as these may help lower headache frequency and severity.

8. Use Migraine Medications

If a migraine attack begins, using medication early may stop the attack or make it easier to manage.

Your healthcare provider may prescribe certain medications for menstrual migraine, such as a triptan. This type of medication is fast-acting and may help manage migraine symptoms if taken early, especially when combined with a nonsteroidal anti-inflammatory drug (NSAID).

Some medications can also be used preventively. For example, your doctor may recommend taking an NSAID like ibuprofen or naproxen twice a day leading up to your period to block prostaglandins, chemicals involved in both cramps and migraine pain.

Triptans can also be used preventively by taking them twice a day during your menstrual period. It’s important to note that taking triptans too often can increase the risk of medication overuse headache.

If you’re unsure which treatment strategies are right for you, talk to your healthcare provider. You should never start or stop any medication without discussing it with your doctor first.

9. Discuss Hormonal Treatment Options

For some people, hormonal therapies may help stabilize estrogen levels to keep them from dropping abruptly and triggering a migraine attack. Estrogen may be used as a pill, skin patch, or vaginal gel.

Hormonal contraceptives, or hormonal birth control, may also help with hormone fluctuations. Birth control may contain estrogen, progestin (lab-made progesterone), or both. It’s available as a birth control pill, contraceptive patch, and vaginal ring.

If you experience migraine with aura, you may not be able to take contraceptives with both progestin and estrogen. A progestin-only birth control option is often prescribed for those who have migraine with aura.

When To Seek Medical Care

If your menstrual migraine attacks are frequent, disrupt your daily life, or involve severe headaches, it’s a good idea to talk with a healthcare provider. Your doctor can help you explore different treatment options, rule out other conditions, and create a personalized migraine management plan that fits your lifestyle and needs. You don’t need to wait for your symptoms to get worse before asking for help.

You should seek emergency care right away if you notice:

• Headaches after a head injury
• New neurological symptoms like trouble speaking, balance issues, vision changes, confusion, tingling or numbness, or seizures
• A headache that feels like the worst headache you’ve ever had

If you are currently taking medications for migraine and notice new side effects or feel like they’re no longer working, you should also talk with your doctor.

Taking Control of Your Menstrual Migraine

Menstrual migraine can feel isolating, especially when attacks are severe or disrupt important days in your life. But because these attacks often follow a predictable pattern, you have a real opportunity to get ahead of them.

By tracking your cycle, adjusting your habits during high-risk days, and working with a healthcare provider on a treatment plan, you may be able to reduce both the frequency and intensity of attacks over time.

Relief looks different for everyone, but with the right strategies in place, it may be possible to find an approach that helps.

Join the Conversation

On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.

What helps you predict or manage migraine attacks around your period? Let others know in the comments below.