From the Guidelines
Headaches before menstrual periods can be effectively managed with preventive treatment, such as daily intake of a long-acting NSAID, like naproxen, or triptan, for 5 days, beginning 2 days before the expected first day of menstruation, as recommended by the most recent guidelines 1. To manage headaches before menstrual periods, also known as menstrual migraines or hormonal headaches, several approaches can be taken.
- Take over-the-counter pain relievers like ibuprofen or naproxen at the first sign of headache, and continue every 6-8 hours as needed.
- For prevention, start these medications 1-2 days before your expected period.
- Applying cold or warm compresses to your head or neck for 15 minutes may provide relief.
- Stay hydrated by drinking 8-10 glasses of water daily, maintain regular sleep patterns, and consider reducing caffeine and alcohol intake before your period.
- Stress-reduction techniques like deep breathing or gentle yoga can help. These headaches typically occur due to the natural drop in estrogen levels before menstruation, which affects brain chemicals involved in pain perception, as noted in recent studies 1. If over-the-counter treatments don't help or headaches significantly impact your daily life, consult a healthcare provider who might recommend prescription medications like triptans or hormonal treatments, such as combined hormonal contraceptives for women with pure menstrual migraine without aura, but not for those with migraine with aura due to the increased risk of stroke 1.
From the Research
Headache Before Menstrual Period
- A headache before the menstrual period is often referred to as a menstrual migraine or catamenial migraine 2, 3.
- Menstrual migraines are separated into two categories: pure menstrual migraine and menstrually-related migraine, with the latter being more common 2.
- The withdrawal of estrogen has been correlated with the onset of menstrual migraines, providing an opportunity for specific treatment with hormone therapies 2.
Treatment Options
- Nonspecific treatments such as abortive and prophylactic non-steroidal anti-inflammatory drugs and triptans are commonly used to treat menstrual migraines 2, 4, 5.
- Hormone treatments, including continuous combined hormonal contraceptives, may also be effective in preventing menstrual migraines 2.
- Other treatments, such as GnRH agonists, selective estrogen receptor modulators, and bilateral oophorectomy, have limited evidence and are not commonly recommended 2.
Timing and Duration of Treatment
- The risk of migraine is increased among women during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation 3.
- Accurate diagnosis and effective treatment strategies are essential to manage menstrual migraines, and individual timing and duration of perimenstrual prophylaxis may need to be defined 3.
- Treating early, when pain is still mild, may be more effective than treating once pain is moderate or severe 6.