Treatment of hormone-related migraine

For some women, migraines are closely linked to their menstrual period. A woman’s blood oestrogen level falls immediately before a period and this is thought to be the trigger for the migraine.

While about a half of all women report some association between their migraines and menstruation, fewer than 10% have pure menstrual migraine, with attacks solely occurring with their period. This can be assessed with the help of a headache diary.

Treatment of an acute menstrual migraine attack is the same as for other types of migraine. Women with regular menstrual cycles (whose period can reliably be predicted) may benefit from short-term preventive therapy, such as:

  • naproxen or mefenamic acid (both NSAIDs) for 4 to 10 days, or
  • oestrogen supplements for 7 days.

If you take one of these treatments, you should start taking it 2 days before a migraine is expected.

Some women find that the oral contraceptive pill aggravates their migraines. In particular, if a woman taking an oral contraceptive starts to experience frequent migraine with aura attacks, she should see her doctor, as there is a small chance she may be at higher risk of stroke. This is especially the case in smokers.

Most women find their migraines improve during pregnancy. However, a small number of women actually develop migraine for the first time in pregnancy. Treatment of migraine in this situation is complicated and best managed by a specialist.

Menopause sometimes aggravates migraine; hormone replacement therapy can often help.

References
  • British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)
  • Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
  • Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.
  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - a revised report of an EFNS task force. European Journal of Neurology 2009;16:968-81. www.efns.org/fileadmin/user_upload/CME_articles/CME_article_2009_September.pdf