What Causes Hormonal (Menstrual) Migraines, and How Can You Stop Them?

Migraines are throbbing, pulsing headaches, with additional symptoms like nausea, vomiting, and light sensitivity. They’re not just bad headaches — they’re complex neurological disorders. And women are three times more likely to experience them than men, which suggests that hormones play a role.

There are various types of migraines, with menstrual migraines being one of them. They usually start during adolescence when regular periods start. They often peak in your 20s and 30s before improving with menopause. 

But any normal hormonal variation can trigger a hormonal migraine. Read on to learn what can trigger menstrual headaches and all other types of hormonal migraines.

What is a menstrual or hormonal migraine?

A hormonal migraine is a migraine due to changing hormone levels. Specifically, a menstrual migraine happens in response to changing hormone levels during the menstrual cycle. 

According to diagnostic criteria, the window when a menstrual migraine occurs is usually in the days just before your period and/or a few days into it. So you might hear it called a “premenstrual” migraine. For some, this is the only time they experience migraines. But some people also have them at other times of the cycle. 

What causes hormonal migraines?

Experts still don’t have a strong handle on the exact cause of migraines, including hormonal migraines. There seems to be a series of complex pain pathways in the brain. And hormones like estrogen may affect these pathways in various ways. Most research has focused on estrogen. However, there’s reason to believe that progesterone and testosterone might also play a role. It’s not clear, though, why hormone changes trigger migraines in some people but not in others. 

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Hormonal migraines can occur with any change in estrogen levels, not only during the menstrual cycle. Here are some examples:

• Perimenopause

• Starting a new hormonal treatment, such as contraception or in vitro fertilization (IVF)

• The first trimester of pregnancy and right after giving birth 

Hormonal migraines often improve when estrogen levels are stable (but that’s not always the case). Examples of this include:

• Second and third trimesters of pregnancy

• Postpartum

• Menopause 

Symptoms of hormonal migraines

Headache pain is the most common symptom of a hormonal migraine. It’s usually located on one side of the head, but it can involve both sides. The pain can start as a dull, widespread pain. It then becomes more localized to a specific area. People often describe it as throbbing, pounding, or pulsating. 

Other symptoms can help separate migraine headaches from other types of headache. These include: 

• Sensitivity to light, noise, and smells

• Nausea and vomiting, stomach upset, and abdominal pain

• Sweating (feeling very warm) or chills (feeling cold)

• Tender scalp

• Loss of appetite

• Dizziness and blurred vision

• Fatigue (feeling tired)

• Diarrhea or fever (rare)

How do hormonal migraines differ from regular migraines?

Migraines differ from person to person in severity, timing, and triggers. In general, menstrual migraines aren’t associated with an aura. They also appear to be more severe, more likely to recur, and harder to treat.

Are migraines a symptom of perimenopause?

Migraines may increase in perimenopause. Estrogen levels change a lot during this phase of life. But after the transition is complete and estrogen stabilizes, headaches may improve. Many women report improvement in their headaches after menopause.

How do you diagnose hormonal migraines?

Migraine is a clinical diagnosis. In other words, there’s no specific test for it. Instead, a healthcare professional will get a detailed history of your headaches. With that information, they’ll figure out if your headaches meet the criteria for migraine. 

Menstrual migraines occur within a 5-day window around your period. The 5-day window is within the 2 days before or 3 days after your first day of bleeding. 

How do you treat hormonal and menstrual migraines?

The first approach is to identify any other headache triggers. A headache diary can help you pinpoint your triggers and possibly avoid them. Of course, it’s often impossible to avoid hormone changes. But it’s helpful to know if anything else is playing a role. 

There’s no specific treatment for menstrual migraines. But the good news is that there are several migraine treatment options:

• Over-the-counter (OTC) and prescription migraine medications: If your migraine comes on suddenly (acute), treatment options include triptans, ergots, and nonsteroidal anti-inflammatory drugs (NSAIDs). These medications treat migraine symptoms when they start. Some people also take them before they think a migraine will start (for example, a few days before their period starts). 

• Migraine preventive medications: If you get migraines more than 4 days per month, experts recommend preventive treatment. It can also help if acute and short-term therapies aren’t enough. There are several migraine prevention options. 

• Hormone therapy: In some situations, hormonal medications — like the pill or patch — can be helpful. A continuous dose (without fluctuating levels) can help stabilize hormone levels and prevent migraines. But they aren’t FDA approved at this time. And they may actually increase headaches for some. Due to an increased risk of stroke, experts don’t recommend hormonal therapy for most people who experience migraine with aura.

• Natural and alternative remedies: Alternative therapies like acupuncture can help with migraines. Mindfulness and breathing exercises can also help.

When to see a healthcare professional

Consider speaking with your primary care provider if you think you have hormone-related migraines. They can help you figure out the best treatment plan and refer you to a headache specialist if necessary. Before trying medications, be sure to ask a healthcare professional about safe options if you’re pregnant or breastfeeding.

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Written by:

Katherine Killoran, MD

Katherine Killoran, MD, is a board-certified gynecologist with more than 20 years of clinical experience.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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