Migraines and periods: why, and what you can do

Losing one to three days every month to pain is not a minor thing. You are not exaggerating, and it is not "in your head."

In France, 20 to 25% of adult women get migraines, three times more than men ^[1]. Among them, 6 in 10 link their attacks directly to their period ^[2].

Menstrual migraine is a clinical entity in its own right, recognised by the International Classification of Headache Disorders (the medical reference for headaches) ^[3]. These attacks last about 30% longer, are more intense, and resist standard treatments more ^[4].

• Pure menstrual migraine: attacks happen only around your period, 2 days before to 3 days after. This affects 7 to 14% of women with migraines ^[3].
• Period-worsened migraine: attacks at other times too, but clearly worse around your period.

Your oestrogens act like a cushion that softens pain signals and steadies the brain's blood vessels. Just before your period, at the end of the luteal phase (the second half of your cycle), their level drops sharply.

It is this rapid drop, not the absolute level, that triggers the attack ^[5]. That is why the migraine often hits the day before or the first day of your period, not at random.

Hormones are not the only cause. Three other factors add up:

• Prostaglandins: these inflammatory molecules, made to contract the uterus, enter the blood and amplify inflammation, including around the brain's vessels.
• Dehydration: hormonal shifts change your body's water balance, and lack of water is a known trigger.
• Magnesium: up to 1 in 2 people with migraines run low ^[6], and levels fall further before the period ^[10].

Each of these links is a lever you can act on.

Telling a tension headache from a migraine is not about ranking suffering, it is about strategy. The right diagnosis leads to the right treatment.

A tension headache squeezes both sides of your head, like a tight band. The pain is diffuse, moderate, with no nausea and no bother from light.

A migraine is often pulsating (throbbing with your heartbeat), on one side, intense. It comes with nausea and hypersensitivity to light, noise, and smells. Some women get an aura before the attack: visual disturbances (bright spots, zigzags) or tingling, lasting a few minutes to an hour ^[3].

This matters: paracetamol, useful for a mild headache, rarely handles a menstrual migraine ^[7]. Migraine-specific treatments (targeted anti-inflammatories, triptans) work differently.

If you recognise migraine in what you feel each month, note it down. This will be valuable for your doctor.

No single solution works for everyone. But the range is wide, from daily habits to targeted treatments, to build with your doctor.

For daily life, a few habits ease the load your body absorbs:

• Hydration: aim for 1.5 to 2 litres of water a day, a bit more around your period ^[8].
• Regular sleep: steady hours and 7 to 8 hours a night, weekends included ^[8].
• Diet: regular meals rich in omega-3 (oily fish, walnuts, flaxseed), without skipping meals ^[9].

These are tools, not orders: experiment without guilt.

On the medical side, several options exist, from prevention to the attack itself:

• Magnesium: 300 to 600 mg a day can cut attack frequency, with few side effects ^[6][10].
• Anti-inflammatories (NSAIDs): started 2 days before your period for 5 to 7 days, as targeted prevention ^[7].
• Triptans: drugs designed for migraine; frovatriptan is studied for prevention around the period ^[7].
• Oestrogen gel or patch: applied to "cushion" the oestrogen drop ^[5]. They are contraindicated if you have migraine with aura, due to an increased vascular risk ^[7].

Your doctor, a GP, gynaecologist or neurologist, will help you build a tailored strategy.