How to prevent menstrual migraines

Menstrual, Hormonal & Menopause Migraine

Menstrual migraines affect over 50% of women.1 Unfortunately, many women have resigned themselves to menstrual migraines because if there is little you can do about your cycle then there is little you can do about your migraines. Right?


There a number of options to treat and prevent, yes, prevent menstrual migraines. To understand how and why these treatments can help, it is worth understanding what’s going on during the month.

How the menstrual cycle affects migraines

Women who have a tendency to get menstrual migraines are those who are sensitive to hormonal fluctuations. They are often experienced just prior to the onset of menstruation. Just before menstruation there is a natural drop in progesterone levels.

The two important females hormones involved are progesterone and estrogen.

Progesterone is a natural steroid hormone involved in the female menstrual cycle that stimulates the uterus to prepare for pregnancy. It is a naturally occurring hormone in the female body that helps a woman perform her feminine functions.

Estrogens or oestrogens (spelling is American and British English usage respectively), are a group of compounds which are important in the menstrual and reproductive cycles. They are also naturally occurring steroid hormones in women that promote the development and maintenance of female characteristics of the body. It is important to note that estrogens are used as part of some oral contraceptives and in estrogen replacement therapy for some postmenopausal women.

Throughout the natural menstrual cycle the levels of these hormones fluctuate. During the cycle, the levels of progesterone and estrogens also change in relation to each other. See the image below for how these levels change throughout the cycle.

This happens as part of being a healthy fertile woman. Those who suffer menstrual migraines may be sensitive to the changes in their estrogen level relative to progesterone.

If this balance is slightly off for what your body requires, then you may have uncomfortable physical symptoms such as PMS, breast tenderness, headaches and, in susceptible women, migraines.

Menstrual cycle

What happens during the menstrual cycle


Timing is important for treatment

Timing is important because it can impact how best to treat your menstrual migraines. Below are different hormonal states that may be causing your regular menstrual migraine.

  • If it occurs just prior to the onset of menstruation then it may be due to the natural drop in progesterone levels.
  • Headaches can also occur at ovulation, when estrogen and other hormones peak.
  • Or it may occur during menstruation itself when estrogen and progesterone are at their lowest.

Knowing when your menstrual migraine occurs will determine the best prevention strategy. A good way to determine when your migraines are occurring is by keeping a record of at least 3 cycles to track exactly when your migraines occuried. Remember to note the precise day(s) of your cycle.

Once you have a clear understanding of which days in your menstrual cycle the migraine is  occurring, then you are in a good position to begin treating it.

Menstrual migraine treatments

Lets look at the key options to help manage your menstrual migraines – medical and non-medical. In summary, you can reduce and potentially eliminate your menstrual migraines through the following:

  • Diet
  • Lifestyle factors
  • Hormonal Balancing
  • Prevention migraine therapies
  • Natural & homeopathic therapies

If there is an imbalance of estrogen in relation to progesterone then a healthy diet is the first step (in fact it should be one of the first steps for all migraine sufferers). You are what you eat. Your diet plays a huge role in your overall health and wellbeing.

And because you’re a migrainur then multiply the importance of diet by 10x. It cannot be over-stated how important what you eat is to your overall health and migraines.

“Nothing else affects our health more than what we eat.” – Alexander Mostovoy, H.D., D.H.M.S., B.C.C.T.

We hear it all the time from the health community something like ‘eat a well balanced diet and you will receive the adequate nutrition you need which can help prevent diseases’. But what if you could reduce your migraines by eating healthier. Would you try to eat the right foods say 5 out of 7 days?

Why is diet important for menstrual migraines?

Estrogen levels require stricter regulation compared to other hormones in your body to ensure our natural rhythm runs smoothly.2 Small variances above or below the normal regulated levels can have significant impacts on your health. Your liver metabolizes estrogen. A healthy liver will rapidly metabolize estrogen but if it is overloaded with medications, artificial substances, chemicals or harmful substances from food or drink it can affect the metabolisation of estrogen.

This is why your diet is important. Your diet is thought to be the biggest factor (up to 90%) affecting your hormones through the exposure to certain chemicals in food products.3

According to Marcy Holmes, NP, Certified Menopause Clinician

“Compared to other hormones such as progesterone, estrogen levels need to be tightly regulated for the “choreography” to run as smoothly as Mother Nature intended — even small excesses or deficiencies of estrogen can have huge effects on your well-being. A healthy liver metabolizes estrogen rapidly into the more benign of its metabolites. But when it’s bogged down with detoxing medications, environmental chemicals, and harmful substances from food or drink, it can over-metabolize estrogen into its less desirable forms, which can pose a real threat to your health if allowed to accumulate.”2

Certain toxins can disrupt your hormonal balance, so try to reduce or eliminate these altogether. Examples of toxins you may commonly come across:

  • MSG (monosodium glutamate) – found as a flavor enhancer in many processed foods.
  • Hydrolyzed Vegetable Protein
  • Aspartamine

avoid or if possible eliminate

And if in doubt of what food triggers you may have, keep a diary and consider a food allergy test. It may even be worth considering a detoxification to help cleanse your system of the offending substances. If you are serious, consulting a health care professional like a nutritionist, dietitian or naturopath is a good idea. Successfully modifying your diet is notoriously tricky to do by yourself and can be dangerous with malnutrition risks if you don’t know exactly what you’re doing. So ensure you do this properly and with professional support. That way you will have the best chance of dramatically reducing your migraines and not starving yourself or being malnourished.

For years I ate food unknowingly that contributed to my headaches. I came to believe that daily headaches was part of my DNA. I thought to myself as long as they weren’t migraines I could manage. But increasingly they were turning into migraines and my condition was getting worse.

Lifestyle factors

Lifestyle factors like sleep and exercise play a central role in the sustainable recovery and management from migraines. The right levels of sleep and exercise are C.R.I.T.I.C.A.L. Sleep is a restorative function for brain and  body. And it is not just about getting enough sleep each night. It’s about how regular your sleep/wake cycle is. Are you going to bed and waking up at the same time each night? What about on weekends?

It’s also about the quality of sleep. Getting 2 hours sleep before midnight with 9hrs total sleep is better than 10 hours sleep after midnight. Are you waking up at the same time each morning?

Nobody is perfect, but the better you can do this, the better for your condition.

Exercise promotes weight loss, hormonal balance, reduces stress, assists in sleep, stabilizes your mood and gives you an overall sense of well-being.

Pick an activity, any activity. It could be yoga, boxing, swimming, tennis, hockey it doesn’t matter, just something you like enough to keep doing. Every 2nd day is still pretty good and twice a week is still better than nothing. Just do something. You don’t have to do something you pay for either, just jog or cycle around the block. Start small and work up to bigger things. You will feel better for it.

When you take care of your body, it is more likely to take care of you.

Hormone Balancing

Hormones can have a significant influence on bodily functions so it is important. But addressing hormones without taking core action on diet and lifestyle factors will not produce sustainable results.

To assess hormone levels tests may involve blood, saliva and urine testing to establish a baseline and to identify any hormonal imbalances which may be contributing to migraines.

Thyroid testing is also important as hypothyroidism is common in migraine sufferers.

For many women problems appear to arise due to the estrogen dominance and progesterone deficiency. In these cases, bio-identical progesterone in the second half of the female cycle to balance the hormones has shown some success.4

It is a good idea to consult a healthcare professional in this area who has experience and a good track record in dealing with migraine patients.

Migraine prevention medications

Medical options that are generically prescribed to migraine sufferers regardless of the causes and can be used to help reduce the frequency or severity of menstrual migraines.

This alternative does not address the root issue. But they can still be very useful when used as intended.

  1. They can help you break the chronic cycle of migraines if they are occurring frequently or
  2. Offer you some time to uncover the underlying causes of your migraine.

However prolonged use is not ideal given the side effects, the cost and the need to address the underlying cause of the migraine in the first place.

When looking at actual medicinal options to explore it is best to discuss these with your doctor with your medical history. To read more about the different treatments available click here.

Natural & homeopathic therapies

Whilst there is less clinical evidence behind the efficacy of natural and homeopathic therapies than there medical counterparts, they typically have less side effects, are safer, natural and non addictive.

That said, if they don’t help, you’ve wasted your money. So do your research before jumping into these kind of treatments to decide if it’s appropriate. Click here to view a more detailed list of alternative therapies.

If you don’t have a well-balanced diet then you may not be getting your required vitamins and minerals. Supplements in this scenario may be useful. Some that have been reported to help migraine sufferers are; Riboflavin, Feverfew, Butterbur, Vitamin B6, Magnesium, Ginger, Coenzyme Q10 and White Willow.

Reducing your menstrual migraines

To summarise: If your migraines are occurring at the same time each month

  1. Keep a record of the exact migraine days for 3 months and make an appointment to see a health care professional.
  2. The most sustainable and lasting treatments address the underlying cause, which are typically:
    • diet,
    • lifestyle factors and
    • hormonal imbalance.
  3. You may need medicinal treatment to provide intermediary support but try not to lean too heavily on this as these can exacerbate headaches if used too often.

Often, it is the things we eat or do unknowingly that are contributing to our condition. Identifying and modifying these with a healthier improvement to your lifestyle and diet is where you can have the most dramatic affect on your overall migraine condition.

Are you willing to make lifestyle changes to improve your migraines or are you happy with the status quo?


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Images Sources:
Female photo credit: Plaits
Menstrual cycle chart: Isometrik
  1. MacGregor E.A., Brandes J., Eikermann A., Giammarco R. (2004) Impact of migraine on patients and their families: the migraine and zolmitriptan evaluation (MAZE) survey-phase III. Curr Med Res Opin 20: 1143–1150
  2. Holmes, M NP, Accessed Oct 2013.
  3. Fürst P (October 2006). “Dioxins, polychlorinated biphenyls and other organohalogen compounds in human milk. Levels, correlations, trends and exposure through breastfeeding”. Mol Nutr Food Res 50 (10): 922–33.
  4. Mostovoy, A. ‘Migraines – Helpful Solutions’ Accessed Oct 15, 2013

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