Dear Alice,

Is there a reason why I get migraines a day before my period and also a few days during it?

Dear Reader,

What a pain in the… head! And, dear Reader, you do not suffer alone. Migraines that occur exclusively around your period (sometimes called perimenstrual migraines) seem to affect between one or two out of every 20 women. They are more common for those in their late 30s, often declining after menopause. It appears that the hormone estrogen and the hormone-like compound prostaglandins are likely the culprits of this painful experience. Let’s explore some of the reasons this pair can cause pain as well as shed some light on treatment options.

The Big E — Estrogen

There seems to be a special relationship between estrogen levels and migraine headaches. Though both men and women produce estrogen, the hormone levels fluctuate much more for females (both during the menstrual cycle and between puberty, reproductive age, and menopause), than for males, whose estrogen levels remain relatively stable throughout their lives. For women, estrogen typically decreases at the end of the luteal phase of the menstrual cycle or when those on hormone therapy are at “trough” (right before their next hormone administration). Studies have shown that minimizing these drops may help reduce migraine frequency. Combined hormonal contraceptives (pills, patches, and rings containing both estrogen and a progestogen) have been shown to have some effect on reducing fluctuations in estrogen subsequently decreasing perimenstrual migraines. It also appears that migraines can occur when estrogen levels are artificially manipulated as well. Scientists have also studied male-to-female transgender women on estrogen hormone therapy and discovered that migraine headaches tended to increase in this group when they began their hormone therapy.

P is for… Prostaglandins!

Prostaglandins are a hormone-like compound involved in the regulation of the menstrual cycle and nervous system functioning. These compounds may also play a role in the regulation of the nerves sensitive to facial pain, also a possible link to perimenstrual headaches.

Prostaglandin levels in the body have been found to be highest during perimenstrual migraine and are often accompanied by dysmenorrhea (aka strong menstrual cramps, typically interfering with normal activities). If you take medicine that inhibits prostaglandin production, you may be able to reduce the likelihood of both perimenstrual migraines and dysmenorrhea.

These are just a couple possibilities that researchers have found that might explain monthly migraines — and future studies will hopefully provide more answers. Perimenstrual migraine can also sometimes indicate a menstrual disorder, such as abnormal hormonal cycles with elevated estrogen levels or excessive menstrual flow — so you might want to check in with your health care provider about possible causes and treatments that are best for you. You may also want to check out the National Headache Foundation for resources and tips.

Hope you find some monthly relief soon!

Alice!

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