If you have headaches that occur between 2 days before your period and in the first 3 days of flow, and if those headaches are more severe, or light bothers you more with those headaches, odds are you have menstrual migraine.

Migraines occurring just before and during menses can be the most challenging kind to treat and frequently do not respond to the same medicines that work the rest of the month. Menstrual migraine is fueled by the drop in usual estrogen levels that occurs just prior to the menstrual period. The menstrual migraine window is considered 2 days before flow starts and continues for the first 3 days of menses.

There are 3 general treatment strategies: acute treatment enhanced to hit these migraines harder than usual migraines, mini-prevention that is a preventive treatment given before and during the menstrual window, and long-term prevention in which a daily preventive treatment is used throughout the month.

 
SUMMARY

Keeping a diary of your headaches, recording when they occur in relation to the menstrual cycle, as well as their severity and response to usual treatment, will help in determining the presence or absence of menstrual migraine, present in about 60% of women with migraine.

Options vary depending on a woman’s overall health and response to treatment. They include stepped-up acute treatment, mini-prevention with NSAIDs, magnesium, triptans or estrogen, or daily prevention with continuous contraception.