It's systematic. Two days before your period, it starts: a dull ache that settles behind your eye, pulsing in time with your heart, and keeping you bedridden in the dark with the urge to vomit. You've tried everything: paracetamol, which doesn't do anything, ibuprofen, which helps a little, coffee, which sometimes makes it worse, and that damn hot water bottle that only soothes your stomach. You are not alone. Between 6 and 20% of women suffer from migraines triggered by their menstrual cycle, and among women who already suffer from migraines, 60% find that their attacks worsen during this time.
This headache isn't "all in your head" (ironic, right?), it's not "just a little stress," and no, it's not an excuse not to go to work. It's a real hormonal migraine, called a catamenial migraine, triggered by the sudden drop in estrogen at the end of your cycle. And yes, there are concrete solutions to relieve it.
⚡ What you need to know (without getting stressed out)
Catamenial Migraine: Definition and Figures
The term "catamenial" comes from ancient Greek and means "monthly." A catamenial migraine (also called menstrual migraine or hormonal migraine) is a migraine directly related to hormonal changes in the menstrual cycle, particularly the drop in estrogen.
Unlike a simple tension headache (a diffuse and less intense headache), catamenial migraine is a true migraine: intense, unilateral throbbing pain (often on one side of the head), accompanied by nausea and hypersensitivity to light and noise.
Key figures
| Overall prevalence | 6 to 20% of women of childbearing age |
| In migraine sufferers | 60% have increased seizures during menstruation |
| Pure catamenial migraine | Only 7% (crises only during menstruation) |
| Women vs. Men | Women are 3 times more affected by migraines (24% vs 7%) |
| Duration of crises | Longer than classic migraines (often 2-3 days vs. a few hours) |
Two types of catamenial migraines
Pure catamenial migraine (rare, 7%) : Crises occur exclusively between D-2 and D+3 of the cycle (2 days before menstruation to 3 days after the start), and never outside this period. Over at least 3 consecutive cycles.
Menstrual-related migraine (common, 60%) : Attacks occur during menstruation but also at other times of the cycle. This is the most common form. Attacks around menstruation are often more intense and longer.
Why You Get a Headache During Your Period
The main culprit? The sudden drop in estrogen at the end of the menstrual cycle. But the exact mechanism is still debated in the scientific community. Here's what we know today.
The Estrogen Drop Hypothesis (Most Accepted)
In the 1970s, researcher Sommerville was the first to demonstrate that injecting estradiol (a form of estrogen) into women with migraines delayed the onset of their migraines by several days. The attack systematically occurred at the same time as estrogen levels dropped sharply after this injection.
What actually happens in your body:
- During the first part of the cycle (follicular phase), your estrogen gradually rises
- At ovulation (around day 14), estrogen peaks, then drops sharply the next day (some women experience a migraine at this time)
- After ovulation (luteal phase), estrogen rises slightly thanks to the corpus luteum
- Just before your period (D-2 to D-1), estrogen and progesterone drop sharply again if you are not pregnant
- This hormonal drop triggers migraines in susceptible women, usually on the first day of menstruation (when estrogen is at its lowest)
💡 The critical threshold : According to studies, migraines are triggered when estrogen drops below 45-50 pg/mL after a prolonged period at higher levels. It is the speed and magnitude of the drop that matters, more than the absolute hormone level.
The role of the trigeminovascular system
Estrogens do not directly cause pain. They act on the trigeminovascular system, the neurological circuit responsible for migraines.
When estrogen drops:
- The trigeminal nerve (located at the base of the skull) becomes hyperexcitable
- It massively releases CGRP (calcitonin gene-related peptide), a pro-inflammatory neuropeptide
- This inflammation causes dilation of the blood vessels in the meninges (the membranes that protect the brain)
- This dilation + inflammation = intense throbbing pain characteristic of migraine
⚠️ Limitations of current studies Despite the widespread acceptance of this hypothesis, scientific evidence remains limited and studies feature variable methodologies. Research continues to better understand the exact mechanism.
Other avenues explored by research
Beyond the drop in estrogen, other factors could play a role:
- Progesterone : Its role remains debated. It also falls before menstruation, but its involvement in migraine is unclear.
- Iron deficiency : Some studies show lower ferritin levels in women with menstrual migraines. Blood loss during menstruation could worsen the condition.
- Histamine : In some women, migraines around ovulation (rather than menstruation) may be linked to a surge in histamine, which is itself linked to estrogen.
- Genetic : Certain genetic polymorphisms (variations in genes) related to estrogen metabolism may make some women more sensitive to hormonal fluctuations.
When Migraine Hits Your Cycle
Hormonal migraines don't just happen in your cycle. They occur at very specific times when estrogen levels drop sharply.
🎯 The 3 risky moments
1. Just before and during menstruation (most common)
Estrogen and progesterone levels drop sharply two days before menstruation. This is when catamenial migraines are most common. Migraines typically begin on the first day of menstruation (D1) or the day before, and can last up to D3.
2. Around ovulation (less common)
Just before ovulation, estrogen peaks. The next day, it drops sharply while progesterone begins to rise. This "hormonal shift" can trigger migraines in some women. If this is the case for you, histamine could also be a factor.
3. When stopping the pill (break week)
If you take a combined pill with a week's break (or a patch/vaginal ring with a break), the drop in synthetic hormones causes the same effect as a drop in natural estrogen. Migraines usually occur between the 2nd and 4th day of stopping.
💡 Tip to identify your pattern : Keep an attack diary for at least 3 cycles. Note the day each migraine started relative to the first day of your period (D1). If the majority of attacks occur between D-2 and D+3, you probably have catamenial migraines. This information will be valuable for your doctor.
Recognizing a Catamenial Migraine
The symptoms of a catamenial migraine are generally the same as a classic migraine, with a few specific features that make it even more distressing.
Typical symptoms
🔴 Severe throbbing pain
Usually on one side of the head (temple, forehead, behind the eye), beating in time with the heart. Aggravated by movement, physical activity, climbing stairs.
🤢 Nausea and vomiting
Present in 80% of migraine sufferers. Can be very disabling, sometimes preventing people from eating or taking medication.
💡 Photophobia and phonophobia
Hypersensitivity to light (even dim light hurts) and noise (every sound seems amplified). Need to isolate oneself in darkness and silence.
😫 Intense fatigue and irritability
Often present even before the onset of pain (prodromal phase). Difficulty concentrating, increased emotional sensitivity.
⚠️ Difference with tension headaches
A tension headache is a "helmet" or pressure-like sensation across the entire head, with diffuse pain on both sides, less intense, and without nausea or sensitivity to light. It responds well to paracetamol and generally doesn't prevent you from continuing your activities. A catamenial migraine, on the other hand, leaves you bedridden.
What Makes Menstrual Migraines Worse
The drop in estrogen is the main trigger, but other factors can worsen the intensity or frequency of attacks. Some are preventable, others are not.
Aggravating factors you can control
💧 Dehydration
Drinking too little water makes migraines worse. During your period, you lose blood (and therefore water), and general inflammation increases. Hydrate more starting two days before your period.
😴 Lack of sleep or irregular sleep
Lack of sleep or irregular schedules (going to bed late, sleeping in on weekends) are powerful migraine triggers. Keep a regular schedule, even on weekends.
🍕 Pro-inflammatory diet
Certain foods can aggravate the condition: refined sugars, ultra-processed foods, excess salt, alcohol (especially red wine), aged cheeses, and cured meats. Test to identify your personal triggers.
😰 Stress and anxiety
Stress increases muscle tension and inflammation. PMS already amplifies anxiety, creating a vicious cycle. Relaxation techniques (yoga, meditation, breathing) can help.
☕ Excess or abrupt cessation of caffeine
Caffeine has a vasoconstrictor effect that can provide relief (which is why it is sometimes recommended). But consuming too much caffeine daily and then stopping it abruptly (weekend, vacation) can trigger a withdrawal migraine.
Factors you cannot control
- Genetic : If your mother or sister has migraines, you are more likely to have them too.
- Weather variations : Sudden drop in atmospheric pressure (stormy weather), extreme temperatures
- Natural hormonal changes : Puberty, pregnancy, postpartum, perimenopause
- Anemia or iron deficiency : Blood loss during menstruation can worsen an existing deficiency, increasing migraines
How to Relieve a Catamenial Migraine
Menstrual migraines are more resistant to conventional treatments, but several approaches can provide relief. The idea: act quickly at the first signs, combine several strategies, and anticipate attacks if they are predictable.
Treat the crisis as soon as it starts
💊 Nonsteroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen (400-600mg) works better than paracetamol for migraines because it reduces inflammation. Naproxen sodium (550mg) has a longer action. Take it as soon as the pain starts, not "to see if it goes away."
⚠️ Attention : Do not use more than 10 days per month (risk of medication overuse headaches). If contraindicated (fragile stomach, asthma), speak to your doctor.
💉 Triptans (prescription)
Triptans (Sumatriptan, Zolmitriptan, Almotriptan) are specific antimigraine drugs. They cause vasoconstriction and block inflammation. They are less effective for menstrual migraines than for classic migraines, but are useful in combination with an NSAID.
⚠️ Contraindications : Hypertension, history of stroke, heart disease, migraine with aura (increased risk of stroke). Limit to 9 days per month maximum.
🧊 Cold on the head
A cold headband, an ice pack wrapped in a cloth, or even a gel mask on the forehead/temples causes vasoconstriction, which can provide relief. Use at the onset of an attack for 15-20 minutes.
🛌 Rest in the dark and silence
Isolate yourself in a dark, quiet, and quiet room. Sensory stimulation (light, noise, movement) aggravates migraines. Close the shutters, put your earplugs in, and put your phone on airplane mode. Try to sleep if possible; sleep helps you recover.
Preventing attacks (preventive treatment)
If your migraines are predictable (always at the same time in the cycle) and disabling, short-term preventative treatment can be very effective.
💊 NSAIDs as a preventative
Protocol : Take an NSAID (naproxen 550mg 2x/day, or ibuprofen 400mg 3x/day) starting 2 days before the expected date of your period, and continue until D+3.
Efficiency : Reduces the frequency and intensity of attacks in approximately 50% of women. Ask your doctor for advice on adjusting dosages.
🩹 Estradiol patch or gel (prescription)
Protocol : Apply an estradiol patch (100μg) or estradiol gel 2 days before your expected period and continue for 7 days. The goal is to prevent a sudden drop in estrogen.
Efficiency : Significantly reduces attacks during the application period. But be careful, some women have a rebound migraine 1-2 days after stopping the patch (when estrogen levels drop again).
⚠️ Contraindications : History of thrombosis, smoking after age 35, migraine with aura. Discuss with your gynecologist.
💊 Continuous pill
If your migraines occur during the week you stop taking your combined pill, taking the pill continuously (without a week off) eliminates the hormonal drops and therefore the associated migraines.
Alternatives : Shorten the stopping window to 4 days instead of 7, or switch to a microprogestin pill (which does not contain estrogen).
⚠️ Attention : The combined pill is contraindicated if you have migraines with aura (increased risk of stroke). Talk to your gynecologist to find the best option.
Natural solutions that can help
These approaches do not replace medical treatments but can effectively complement them.
💧 Massive hydration
Drink 2 to 2,5 liters of water per day, starting two days before your period. Add electrolytes if needed (coconut water, rehydration drinks). Dehydration always makes migraines worse.
🧘♀️ Stress management
Yoga, meditation, cardiac coherence (5 min, 3x/day), sophrology, acupuncture. Try what works for you. The goal: reduce activation of the sympathetic nervous system ("alert" mode) that aggravates migraines.
💊 Magnesium
300-400mg/day of magnesium (bisglycinate or citrate for better absorption) as a continuous course. Several studies show a reduction in migraine frequency after 3 months of supplementation. Additional benefit: also helps with menstrual cramps.
🌿 Peppermint
Diluted peppermint essential oil (2-3 drops in a carrier oil), massaged into the temples and back of the neck. Refreshing and slightly analgesic effect. Caution: not during pregnancy/breastfeeding, and never pure on the skin.
🌙 Regular sleep
7-9 hours a night, with fixed bedtimes and wake-up times (even on weekends). Lack of sleep and schedule variations are major migraine triggers.
❌ What doesn't work (or hardly works)
- Paracetamol alone : Too weak for migraines (even if sold as "anti-migraine"). May help at the start of a mild attack, but often insufficient
- Homeopathy : No scientific evidence of effectiveness on migraines. If it relieves you, it's probably the placebo effect (which exists and can help!) but don't rely on that alone.
- Too much coffee : A cup at the beginning of an attack can help (vasoconstrictor effect), but too much daily caffeine creates addiction and withdrawal migraines. Use in moderation
Special Cases: Pill, Pregnancy, Menopause
Hormonal fluctuations throughout life directly influence catamenial migraines. Some periods make them worse, while others significantly improve them.
Hormonal contraception and migraines
The link between the pill and migraines is complex and varies from one woman to another. The same pill can improve migraines in some, worsen them in others, or have no effect at all.
Combined pill
Contains synthetic estrogen and progesterone. In 30-40% of women, it does not affect migraines. In others, it can improve them (hormonal stabilization) or worsen them (especially during the week of withdrawal when hormones drop).
⚠️ Absolute contraindication : If you have migraines with aura, the combined pill is contraindicated (risk of stroke increased by 2 to 6 times). It is imperative that you speak to your doctor.
Microprogestin pill (estrogen-free)
Contains only progesterone. Generally neutral for migraines (neither improves nor worsens). Good option if you have migraines with aura or if the combination pill makes your migraines worse.
Hormonal or copper IUD (coil)
Both types (hormonal Mirena/Kyleena, or copper IUD) generally do not affect migraines because the action is local. The copper IUD does not contain any hormones, so there is no systemic hormonal impact.
Pregnancy: the truce (often)
Approximately 60 to 90% of women with migraines experience a marked improvement or complete disappearance of their migraines during pregnancy, especially from the second trimester onward. Women with catamenial migraines are most likely to benefit from this effect.
Why ? During pregnancy, estrogen levels remain very high and stable (no cyclical fluctuations). This hormonal stability protects against the onset of seizures.
⚠️ The other side of the coin : After childbirth, when hormones drop sharply, many women experience a surge of migraines in the first few weeks postpartum. They usually return to pre-pregnancy levels after a few months.
Perimenopause: The Roller Coaster
La perimenopause (the years before full menopause, usually between the ages of 45 and 55) is often a difficult time for migraine sufferers. Hormonal fluctuations become erratic and unpredictable, increasing the frequency and intensity of attacks.
Once menopause sets in (absence of periods for 12 consecutive months), migraines generally decrease significantly or disappear completely in the majority of women (70-80%).
💡 Hormone replacement therapy (HRT) : If you are taking HRT for menopausal symptoms, choose transdermal forms (patch, gel) rather than oral forms. Patches provide estrogen more steadily, reducing the risk of triggering migraines.
Living with Menstrual Migraines
Catamenial migraines aren't just "a headache." They impact your professional, social, and family life. Here are some concrete strategies to help you better manage them on a daily basis.
Anticipate and plan
- Keep a seizure calendar : Record the date of each migraine in relation to day 1 of your period for 3 cycles. You will likely see a clear pattern emerge.
- Block out your risky periods : If possible, avoid important meetings, stressful events, or social engagements during your risk window (D-2 to D+3). This isn't being "weak," it's being strategic.
- Prepare a crisis kit : Medication, hot water bottle, cold pack, earplugs, sunglasses, water. Keep one at home and one at work/in your bag
- Informez votre entourage : Warn your family/partner that "that week" you may be at a loss. Ask for practical support (shopping, children, housework) if needed.
At work
- You don't have to justify yourself Migraine is recognized by the WHO as one of the most disabling conditions. If you have to stop, stop. Taking sick leave is perfectly legitimate.
- Possible arrangements : Teleworking during your risk periods, flexible hours, possibility of isolating yourself in a quiet room, suitable lighting (avoid neon lights)
- Talk to occupational health : If your migraines are frequent and disabling, occupational health may recommend work adjustments
📱 Useful apps
- Migraine Buddy : Detailed seizure tracking, trigger identification, report generation for your doctor
- Clue or Flo : Menstrual cycle tracking, period prediction to anticipate migraines
- Migraine Logbook : Headache Logbook with Statistics
🚨 Warning signs: seek emergency medical attention if...
- Sudden and intense migraine like never before ("thunderclap"), occurring in a few seconds
- Migraine accompanied by high fever, stiff neck, confusion
- Sudden onset of neurological problems (weakness on one side of the body, speech disturbance, persistent double vision)
- Migraine after head trauma
- Abrupt change in the usual pattern (intensity, duration, different symptoms)
Consult your doctor if: Your migraines are becoming more frequent (more than 15 days per month), the usual treatments are no longer working, they are preventing you from living normally, you are taking painkillers more than 10 days per month.
Live Your Period Peacefully
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Take Control of Those Migraines
Menstrual migraines aren't inevitable. Triggered by the sudden drop in estrogen two days before your period, they affect 6 to 20% of women and are longer, more intense, and more resistant to treatment than classic migraines. The mechanism is clear: the hormonal drop makes the trigeminal nerve hyperexcitable, triggers inflammation, and dilates the cerebral vessels.
Ultimately, the winning strategy combines rapid action at the first signs (NSAID, rest, cold, hydration) and anticipation if your attacks are predictable (preventative NSAID, estradiol patch, continuous pill). Natural solutions (magnesium, stress management, regular sleep) are effective complements. Keep an attack calendar for 3 cycles to identify your pattern, and consult if it becomes unmanageable. You don't have to endure this every month in silence.
Sources & Scientific References
This article is based on recent scientific studies and publications in peer-reviewed medical journals.
Studies on prevalence and epidemiology
- Vetvik KG, MacGregor EA. (2017). Sex differences in the epidemiology, clinical characteristics, and pathophysiology of migraine. Lancet Neurol, 16(1):76-87. DOI: 10.1016/S1474-4422(16)30293-9
- Stewart WF, Lipton RB, Chee E, Sawyer J, Silberstein SD. (2000). Menstrual cycle and headache in a population sample of migraineurs. Neurology, 55(10):1517-1523. DOI: 10.1212/wnl.55.10.1517
- MacGregor EA, Hackshaw A. (2004). Prevalence of migraine on each day of the natural menstrual cycle. Neurology, 63(2):351-353. DOI: 10.1212/01.wnl.0000133134.68143.2e
Mechanism: Estrogen Drop Hypothesis
- Pavlović JM, Allshouse AA, Santoro NF, et al. (2016). Sex hormones in women with and without migraine: Evidence of migraine-specific hormone profiles. Neurology, 87(1):49-56. DOI: 10.1212/WNL.0000000000002798
- Gupta S, McCarson KE, Welch KM, Berman NE. (2011). Mechanisms of pain modulation by sex hormones in migraine. Headache, 51(6):905-922. DOI: 10.1111/j.1526-4610.2011.01908.x
- Ornello R, Frattale I, Caponnetto V, et al. (2023). Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. J Headache Pain, 24(1):127. DOI: 10.1186/s10194-023-01664-4
Role of estrogens and the trigeminovascular system
- Nappi RE, Albani F, Sances G, Terreno E, Brambilla E, Polatti F. (2009). Headaches during pregnancy. Curr Pain Headache Rep, 13(3):237-240. DOI: 10.1007/s11916-009-0040-8
- Martin VT, Behbehani M. (2006). Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis. Headache, 46(3):365-386. DOI: 10.1111/j.1526-4610.2006.00413.x
- Chai NC, Peterlin BL, Calhoun AH. (2014). Migraine and estrogen. Curr Opin Neurol, 27(3):315-324. DOI: 10.1097/WCO.0000000000000091
Treatments and prevention
- MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A. (2006). Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology, 67(12):2159-2163. DOI: 10.1212/01.wnl.0000249114.67130.d5
- Calhoun AH. (2012). A novel specific prophylaxis for menstrual-associated migraine. South Med J, 105(11):563-566. DOI: 10.1097/SMJ.0b013e31826d5fc5
- Silberstein SD, Holland S, Freitag F, et al. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults. Neurology, 78(17):1337-1345. DOI: 10.1212/WNL.0b013e3182535d20
Official French resources
- Ameli.fr. Migraine: symptoms, triggers and progression. Ameli Link
- Inserm. Migraine – An increasingly well-known disease. Inserm link
- French Society for the Study of Migraines and Headaches (SFEMC). Recommendations for the diagnosis and management of migraine. Link
