After several months of getting migraines every two weeks, like clockwork, I finally opened up my calendar, determined to figure out what was triggering them. As I scrutinized the dates of my episodes, I started to connect the dots. Why did I have symptoms every day for those particular weeks in December, and then not again until January? And why did that pattern repeat itself every month?
That’s when it clicked: My period was the trigger.
My husband and I practice for our family planning needs, so I know the ins and outs of my cycle like the back of my hand. Whenever my period started, so did the migraines; whenever I ovulated, they disappeared. I talked to my doctor, who agreed that my migraines weren’t random—they were menstrual.
What are menstrual migraines?
Migraines triggered by hormone fluctuations in a woman’s monthly cycle are considered menstrually-related migraines (MRM), which the National Institutes of Health classifies as any migraine episode that occurs up to two days before the onset of a period and three days after, for at least two out of three periods.
"Some studies have identified that about 70 percent of women with a migraine have MRM, while others have shown more conservative numbers of 40 to 50 percent,” says Jelena Pavlovic, attending neurologist and assistant professor at New York’s Montefiore Health System. "But a menstrual migraine is often underreported and underdiagnosed because, in many women, the attacks often start prior to the onset of bleeding and/or do not last the whole menstrual period."
Why does menstruation have the power to trigger migraines in so many women? Blame estrogen.
"Menstrual migraine is commonly thought to be 'triggered' by the late-luteal phase [or premenstrual] drop in estrogen," says Pavlovic.
How can you treat it?
There are no specific treatment options identified solely for MRM, but a combination of traditional migraine treatments, , and hormone-related strategies can be effective.
Nonsteroidal anti-inflammatory (NSAID) drugs
OTC or prescribed NSAIDs, like ibuprofen and naproxen, can be a first line of defense in treating migraines, though they may not quite do the trick. A 2013 review of clinical trials showed that the effectiveness of naproxen often depends on the severity of the migraines and whether it’s being used in conjunction with other medications.
Triptans are a type of drug that work to reduce the swelling of blood vessels in the head, are one of the more popular prescription medication options for migraines.
"A long-acting triptan may be used preventively, beginning about a day before the expected onset of symptoms and continuing for the usual length of symptoms," says Pavlovic. "For this method to work it is important that a patient has a regular menstrual cycle and keeps a good headache diary, so she can calculate when her migraines are likely to start and can make a plan to avoid other triggers."
For women who don't find much relief with non-hormone treatments, transdermal estradiol (like in an estrogen patch) can help. Since MRM is linked to low levels of estrogen, raising those levels around the time patients normally experience migraines is a potential solution.
"[Transdermal estradiol] can be applied for a week, starting about five to seven days premenstrually and continuing through the second day of bleeding," says Pavlovic. Again, this method is preventative, so it helps to be able to track and predict your menstruation.
It's no coincidence that some OTC painkillers for migraines include a combination of aspirin, acetaminophen and —according to the Cleveland Clinic, the stimulant is sometimes used as a treatment for migraines, though it can also contribute to migraines and cause rebound headaches.
Holly Lucille, a private-practice naturopathic physician and educator, says caffeine works on multiple levels to assist with migraines: "It's often considered a taxi that moves pain-relief ingredients quickly through the bloodstream, but it's actually a pain-reliever in its own right."
However, a 2016 study in The Journal of Headache and Pain suggests that the discontinuation of caffeine intake gives migraine sufferers better results. Pavlovic agrees. "In those who have frequent headaches, daily caffeine intake can worsen them and lead to more headaches. They are advised to limit, if not completely cut out, caffeine from their diet."
Magnesium is pretty widely accepted as a potential remedy. "Magnesium may be in short supply in those who suffer from migraines, acting as a co-conspirator with hormone fluctuations in causing the condition," says Lucille.
"Magnesium has been used primarily as a preventive agent for menstrual migraines," adds Pavlovic. The American Migraine Foundation also acknowledges that magnesium is a reliable preventative strategy with an “excellent safety profile.” (Just remember to consult a doctor before taking any dietary supplements.)
This article originally appeared on WomensHealthMag.com. Minor edits have been made by the Cosmo.ph editors.