As if it weren’t enough that women get PMS headaches, they’re also more vulnerable to migraines, a particularly painful type of headache that is sometimes accompanied by nausea, vomiting, and visual disturbances. Approximately 29.5 million people get migraines and nearly 70 percent of them are women. Overall, migraines are most common in people between the ages of fifteen and fifty-five, which also happens to be the span of time when most women menstruate.

So what causes migraines? Physiologically, migraines are caused by neural changes in the brain, but stress, diet, bright lights or noises, weather changes, a lack of food or sleep, and emotional distress are among the common triggers—and, of course, hormones.

Classic Versus Common

There are two forms of migraine: classic and common. A classic migraine includes visual symptoms (known as aura) that precede the headache by ten to thirty minutes. The person may see flashing lights or zigzag lines, may have blind spots, or may even lose vision for a time. There may also be sensory problems, such as disturbances in the sense of touch, taste, or smell. In common migraines, no aura. However, the person does have other migraine symptoms, such as nausea and vomiting.

Menstrual Migraines

Up to 60 percent of women who experience migraines get during their periods or at ovulation. Known as menstrual migraines, these headaches appear to be caused by the dropping hormone levels that coincide with the period. As estrogen drops, the brain’s ability to block pain sensation, which may trigger migraine. Researchers have several theories on the causes migraines:

  • Falling estrogen levels trigger migraine headache by levels or brain chemicals such as serotonin, dopamine, and endorphins.

  • Serotonin, a known culprit in migraines, is affected As estrogen falls during the menstrual cycle, it’s to disrupt the serotonin system and trigger a headache.

  • Prostaglandins, which have been shown to cause migraines, trigger menstrual migraines when they are released bloodstream during a woman’s period.


An aura is a sensation of flashing lights or zigzag lines or a temporary loss of vision that often precedes a migraine headache. It is a warning that a migraine is about to occur. About 15 percent of people experience an aura before a migraine attack. The aura may last as long as an hour and will fade as the headache begins.

Ovulation Migraines

Another variation of menstrual migraine occurs at mid-cycle and is sometimes called the ovulation migraine. Fewer women report mid-cycle symptoms than migraine during their periods.

Given their timing, ovulation migraines appear hormonal. Although estrogen levels are high just before ovulation, women do experience rapid hormonal fluctuations. Experts believe these fluctuations disrupt the serotonin system and cause headaches. In other words, it’s not the actual level of estrogen that triggers migraine but how the rapid shifts in estrogen impact serotonin. This same process is thought to underlie migraines that occur in some women who take birth control pills. According to the American Council for Headache Education, women who take oral contraceptives in which the doses and proportion of estrogen and progesterone vary tend to have migraine attacks during the week they take placebo pills, when hormone levels drop. This suggests that plummeting estrogen levels may trigger migraine. However, the exact nature of how oral contraceptives may or may not contribute to migraine is unknown.


Your risk of migraine is highest in the first two days of your period. A 2000 study by researchers at the Headache Center at Thomas Jefferson University Hospital in Philadelphia found that women are twice as likely to experience a migraine without aura during the first two days of their cycle than at any other time of the month.

Oral Contraceptives

Oral contraceptives can both improve or worsen PMS symptoms, but in the case of migraines, many women find birth control pills actually trigger their migraines. A 2006 study of nearly 14,000 women in Norway found that migraines were 40 percent more common among women taking oral contraceptives. These women were 20 percent more likely to suffer nonmigraine headaches.

Estrogen is thought to be the hormonal culprit in this case. control pills can produce a fourfold increase in a woman’s level. As a result, when women take their week’s worth pills, they experience a rapid fall in estrogen, causing migraines during their “periods” (in the case of women taking control pills, this is actually withdrawal bleeding rather actual period). Some women find that taking continuous oral in which the hormonal dose remains constant throughout the cycle, can relieve their migraines.


What are oral contraceptive placebo pills?

Placebo pills contain no medical ingredients, only inactive ingredients. Women take pills that contain hormones for three weeks and placebos for one week. The inactive pills cause the withdrawal bleeding that many women think of as their period.

Depression and Migraine

Until fairly recently, many doctors believed that migraine became depressed because their pain was so However, research in the last decade has shown that between major depression and migraines is biological rather psychological.

Researcher Naomi Breslau, Ph.D., a professor of psychiatry at Detroit's Henry Ford Health Sciences Center, conducted several studies on this subject. A 2001 study of more than 4,700 people between the ages of twenty-five and fifty-five found that people suffering from migraines had a greater chance of suffering from major depression than those not experiencing migraines. Similarly, people who suffered from major depression had a significantly higher chance of experiencing migraines than those who were not suffering from depression. In other words, the study suggests that depression did not simply arise from migraines, but instead the relationship between major depression and migraines worked in both directions.

Depression is already a key factor in PMS. Women who suffer from depression are more likely to suffer other types of PMS symptoms; research now confirms that they are also more likely to suffer from migraines.

Treating Menstrual Migraines

Usually, NSAIDs (nonsteroidal anti-inflammatory drugs) are the first line of defense against menstrual migraines. NSAIDs come both over-the-counter (aspirin, ibuprofen, and naproxen) and prescription form (fenoprofen calcium, mefenamic acid). Sometimes, doctors may fight fire with fire by using the hormones to treat these hormone headaches. Triptans are the newest class of drug to treat menstrual migraines. These drugs chemically resemble serotonin they are able to interact with the brain’s serotonin system.

Migraine Therapies

Preventive treatment usually starts one to two days before the menstrual migraine and may be continued for five to ten days.

  • NSAIDs: These drugs reduce inflammation by inhibiting enzyme that makes prostaglandins. NSAIDs include aspirin, ibuprofen, naproxen sodium, fenoprofen calcium, and mefenamic acid.

  • Ergotamines:These drugs are derived from an ergot fungus that constricts blood vessels.

  • Estrogen:This hormone is usually given in synthetic in oral contraceptives.


If you have significant headache pain that lasts more than a few your headaches wake up from sleep, you get frequent headaches no known cause, or your headaches have changed in pattern or intensity, see a doctor for a medical diagnosis. A study of self-described sinus headache sufferers found that the vast majority had misdiagnosed themselves and were actually suffering from migraines.

Headache Diary

How can you tell if you get PMS headaches or menstrual migraines? The first step is to keep a headache diary, which will you track the severity, frequency, and length of your pain possible triggers for your headache. It will also tell you if your occur at ovulation, at menstruation, or during the luteal of your cycle. You can use a notebook to create your diary, your headaches on one of the several versions of headache that are available on the Internet. Be sure to note the date and your headache begins, its intensity, symptoms, and triggers, of medication you use to treat it, and whether it resolves your Include these questions in your headache diary:

  • When did you start having headaches?

  • How often do you get them?

  • Is there a time of day or week they usually occur?

  • Do you have pain on one or both sides of your head?

  • What kind of pain is it? Throbbing? Pulsing?

  • Do you have any other symptoms, such as vomiting or nausea?

  • What triggers your headaches? Foods, activities, lights, noise, strong odors, smoke, stress, oversleeping?

  • Does anyone else in your family suffer from headaches?

  • How long do your headaches last?

  • Do you have visual disturbances before your headaches?

  • Do your headaches coincide with your menstrual cycle?

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