If you notice a headache creeping in around the middle of your menstrual cycle, hormones may be to blame.

Ovulation migraine is a lesser-known type of hormonal migraine that strikes when estrogen shifts sharply around ovulation. Here’s what causes it, how to spot the pattern, and what you can do about it.

What Is an Ovulation Migraine?

An ovulation migraine is a migraine attack that occurs around ovulation when the egg is released from the ovary.

Only a small percentage of people with migraine experience ovulation migraine attacks. For most people with migraine, the risk of headache is significantly lower around the time of ovulation. The highest risk is just before and during the first two days of menses.

Like other types of migraine, these attacks can cause throbbing head pain, often on one side, along with nausea, light sensitivity, and sound sensitivity.

What makes ovulation migraine unique is its timing. Ovulation migraine attacks usually happen about halfway through the menstrual cycle, around day 14 of a 28-day menstrual cycle.

Common Symptoms of Ovulation Migraine

Symptoms of ovulation migraine attacks are similar to other types of migraine and may include:

• Pulsating or throbbing pain on one side of the head or both
• Nausea
• Vomiting
• Sensitivity to light or sound

Some people may also experience migraine with aura, which can include visual disturbances and sensory changes, before or during an attack.

Ovulation Migraine versus Menstrual Migraine

Hormone-related migraine attacks aren’t all the same. The timing and pattern can help differentiate the specific type of migraine you may have.

Some key differences between ovulation migraine and menstrual migraine include:

• Timing — Ovulation migraine attacks usually happen midcycle when you’re ovulating, while menstrual migraine attacks happen just before or during a period.
• Estrogen levels — Ovulation migraine is linked to a rapid increase and decrease in estrogen, and menstrual migraine is generally triggered by estrogen withdrawal, or a sudden drop, as menstruation begins.
• Predictability — Ovulation migraine may be less predictable than period migraine unless tracked carefully.

Also, because menstrual migraine attacks might occur alongside period symptoms like cramps, fatigue, or pelvic pain, these attacks may feel longer or more severe than other types of migraine.

Who’s Most Likely To Get Midcycle Migraine Attacks?

In general, women are three times more likely to experience migraine compared to men, which may largely be due to hormonal triggers.

Migraine attacks tied to hormone changes are most common in people who:

• Already have a history or family history of migraine
• Are in their reproductive years or get their period

Lifestyle factors like stress, sleep habits, and diet can also affect who develops migraine and how severe the attacks are.

Some people are also more sensitive to hormone fluctuations. Studies suggest that those with migraine may have a heightened response to normal estrogen changes, which could make them more likely to experience a hormone-triggered attack.

Managing Ovulation Migraine

Treatment for ovulation migraine generally includes both short-term pain relief and preventive strategies.

Pain-relieving Treatments

Acute medications are taken when a migraine starts (abortive therapy), and these can include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetylsalicylic acid
• Prescription drugs called triptans (serotonin receptor agonists), gepants (CGRP receptor antagonists), and ditans (serotonin receptor agonists)
• Anti-nausea medication if your migraine symptoms often include nausea or vomiting

Depending on the specific type recommended by your healthcare provider, acute medication may be available as oral pills, nasal sprays, or injections.

Simple steps like resting in a dark room, staying hydrated, and using a cold compress during a migraine attack may also help relieve symptoms.

Preventive Strategies

If your migraine attacks happen regularly, your doctor or migraine specialist may suggest taking preventive medications before an attack happens.

Preventive medications may help reduce how often migraine attacks happen, how severe they are, and how long they last. Options may include antidepressants, medications that lower blood pressure, anti-seizure medications, botulinum toxin (such as Botox) for chronic migraine, CGRP monoclonal antibodies, and preventive gepants.

If your migraine is tied to ovulation, your healthcare provider may recommend hormonal contraceptives, such as birth control pills, to regulate your hormone levels. If you’re already taking a form of hormonal birth control, they may recommend switching to a different type.

Preventive care can be especially helpful when migraine attacks are predictable and tied to the menstrual cycle.

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