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Migraines and Your Menstrual Cycle

A migraine is not just a headache; it is a biological disorder of the central nervous system. The exact cause of migraines is unclear, but may occur when blood vessels of the head and neck spasm, decreasing blood flow to the brain. This can cause pain instantly or hours later.

Millions of people around the world suffer through the debilitating and hard to treat pain of recurrent migraines. Migraines are basically severe intermittent pounding headaches accompanied by sensitivity to light. Sufferers experience specific symptoms, and often recognize the onset of a migraine. Migraine symptoms vary from person to person in intensity, character, frequency and duration. Attacks can appear a couple of times a year or almost every day.

Types of Migraines

The Common Migraine is a migraine without any warning or aura. Children often experience common migraine.

Common Migraine Symptoms:

  • Throbbing or pounding pain – Migraine pain in the head is characterized by a relentless throbbing or pounding, unlike other forms of head pain. The pain usually begins at the temple on one side of the head, and may spread downward to the eye, face, and even neck.
  • Nausea and vomiting with severe headache – While nausea and vomiting can be caused by a number of factors, it may also accompany migraines.
  • Pain located on one side of the head – Throbbing pain only on one side of the head, usually around the temple, is a common complaint of migraine sufferers. Migraines occasionally cause pain all over the head.
  • Pain aggravated by activity – Movement may be difficult if you have a migraine, and activity may aggravate the pain.
  • Sensitivity to light, sounds, and smells – Sufferers may experience strong, painful reactions to light, loud noises, and certain odors.

While it is not necessary to have all symptoms, they can be moderate to severe. Migraine attacks can last between four hours to three days if left untreated. The need for bed-rest during these attacks may interfere with work, family and social obligations.

The Classical Migraine is a migraine with aura. Only about 15% of all migraine sufferers experience aura, which is the term for the visual, auditory, or other sensory or physical signs of pain to come. These signals occur shortly before the migraine pain starts.

Warning Signs: Aura

  • Visual Disturbances: Visual auras may appear as flashing lights, zigzag lines, and blurred and lost vision.
  • Numbness: A loss of sensation in one or more parts of the body.
  • Hallucinations: Imaginary perceptions not caused by anything external. Sight or sound hallucinations are most common.
  • Loss of Speech: Temporary loss of speech may occur during migraine.

Prodromes are signals that occur hours or days prior to an attack.

Warning Signs: Prodromes

  • Excessive Yawning
  • Fatigue
  • Mood Changes
  • Food Craving
  • Light, Sound, Touch, Odor Sensitivity


In order to diagnose a migraine, a physician who will conduct a physical and neurological examination, and may order a MRI or a CAT scan. Because migraines often run in the family, family history of headaches is also taken into consideration. If no underlying conditions are uncovered then the physician may make diagnosis of migraine.

Pain Medication

Often over the counter painkillers typically do not alleviate migraine pain. Special migraine medicines prescribed by a doctor are more effective and can stop or help relieve the pain. Many new medicines are on the market offering a wide range of pain relief options.

Migraine Prevention

Avoiding migraines may be as simple as recognizing things that can trigger attacks.

Common Triggers:

  • Stress
  • 2 days before, and the first 2 days of menstruation (women only)
  • Missed or delayed meals
  • Overusing headache medications
  • Medications that cause swelling of the blood vessels
  • Bright lights, loud noises, watching television, bright sunlight
  • Certain foods

Common Foods to Avoid:

  • Cheese, and foods containing cheese
  • Certain fruit and vegetables, and fruit juices
  • Caffeine in drinks and foods
  • Chocolate
  • Monosodium Glutamate (MSG)
  • Processed Meats
  • Alcohol, especially red wine

Determining what makes you likely to have a migraine and changing your habits accordingly is the best treatment for migraine.

Migraines and Women

Migraines are most common in women and usually start between the ages of 10 and 46. Approximately 16% of women in the U.S. experience migraines, and about 3.5 million women experience one or more attack a month. Women have about three times as many migraines as men do.

The Estrogen Factor

The medical community believes that one reason women have more migraines than men is their higher level of estrogen. It is believed that estrogen levels are key to the higher incidence of migraine in women, especially during the menstrual cycle.

Up to 19% of women who have migraines experience menstrual-related migraines. These usually occur a few days before and during menstruation, and generally don’t have an aura and last up to 3 days.

One current theory is that menstrual-related migraines are caused by the loss of estrogen during the menstrual cycle. Another idea is that fluctuations of estrogen, from highs present early in the cycle to the lows that occur at the late stage, trigger menstrual-related migraines. If these monthly estrogen highs and lows were evened out, it may be possible to prevent or reduce menstrual migraines.

Speaking to a doctor about menstrual-related migraines, and the option of stabilizing hormone levels may allow sufferers to better manage these migraines.

Questions to ask your doctor about migraine:

  • What do you think causes migraines such as mine?
  • Do you think migraine conditions such as mine are treatable?
  • If the drug prescribed doesn’t work for me or has too many side effects, what alternatives are available?

Work closely with your doctor to find the best way to better manage your migraines. One way you can assist your doctor in treating your migraine pain is to complete the following MIDAS questionnaire. The purpose of the questionnaire is to help you determine the severity of your migraine pain and the level of disability you experience.

The Migraine Disability Assessment (MIDAS) survey consists of a few questions that will help measure the impact headaches have had on your life over the last 3 months. Write your answer in the box below each question, and write zero if you did not engage in the activity in the last 3 months. After you have answered the 5 questions, add up the total number of days from questions 1-5 (don’t include A and B). If your total is more than 6, we suggest that you make an appointment to see your doctor.

1. Lost days from work:

On how many days in the last 3 months did you miss work or school because of your headaches? (If you do not attend work or school enter zero in the box.)

Days: _____

2. Lost productivity days at work or school:

How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed work or school. If you do not attend school or work enter zero in the box.)

Days: _____

3. Lost household workdays:

On how many days in the last 3 months did you not do household work because of your headaches?

Days: _____

4. Lost productivity days at home:

On how many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? (Do not include days you counted in question 3, where you did not do household work.)

Days: _____

5. Lost social days

On how many days in the last 3 months did you miss family, social, or leisure activities because of you headaches?

Days: _____

Total: _____

A. On how many days in the last 3 months did you have a headache? (If the headache lasted more than 1 day, count each day.)

Days: _____

B. On a scale of 0-10, on average, how painful were these headaches? (Where 0 = no pain at all, and 10 = pain which is as bad as it can be.)

Days: _____

I Little or no disability 0-5
II Mild disability 6-10
III Moderate disability 11-20
IV Severe disability 21+

Your MIDAS score: _____

(Don’t include A and B.)

If your score total is more than 6, you should share this information with your doctor.

Thomas G. Stovall, M.D.

Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women’s Health Specialists, Inc.