Are migraines during menstruation common?

Menstrual Migraines Are Common

Yes, migraines during menstruation are very common—approximately 50% of women with migraine experience increased attacks during their menstrual period, though only about 8% have attacks exclusively related to menstruation (pure menstrual migraine). 1, 2

Prevalence and Patterns

• Menstrually-related migraine (attacks occurring both during menstruation and at other times) affects approximately 6-7% of women, while pure menstrual migraine (attacks exclusively with menstruation) affects only about 1-8% of women 1, 3

• Clinical experience suggests that 50-70% of female migraineurs report increased headache frequency at the time of menses 4, 2

• The attacks typically occur during the greatest fluctuation in estrogen levels—specifically during the 2-3 days before and the first days of menstruation when estrogen drops precipitously 4, 2

Clinical Characteristics

Menstrual migraines have distinct features that make them particularly challenging:

• Usually occur without aura, unlike migraines at other times of the cycle 1, 5

• More severe, longer-lasting, and more resistant to treatment compared to non-menstrual attacks due to hormonal influences 3, 5

• The estrogen withdrawal during the perimenstrual period is the primary trigger in susceptible women 4, 2

Association with Other Menstrual Disorders

Women with chronic migraine (≥15 headache days per month) have significantly higher rates of menstrual-cycle disorders compared to those with episodic migraine:

• Menstrual-cycle disorders in general: 41.2% vs 22.2% 6
• Dysmenorrhea: 51.0% vs 28.9% 6

Clinical Implications

The high prevalence means that any woman of reproductive age presenting with migraine should be asked about the relationship between her attacks and menstruation 1. This requires prospective headache diaries for at least three menstrual cycles to confirm the pattern before initiating menstrual-specific treatments 5.

If optimized acute medication therapy does not suffice for women with confirmed menstrual migraine, perimenstrual preventive treatment should be initiated with a long-acting NSAID (such as naproxen) or triptan (such as frovatriptan or naratriptan) for 5 days, beginning 2 days before the expected first day of menstruation. 1, 7