Migraine and hormones

Migraine attacks just before or during a period can last longer and be more severe than attacks at other times. They are often called menstrual migraines. A link with periods is worth discussing, especially if the attacks are disrupting your plans or becoming difficult to control.

Hormones are part of the picture

The exact link between migraine and the menstrual cycle is still unclear. Falling oestrogen and progesterone around the start of a period may trigger an attack. Many people who have migraine around periods also have attacks at other times. Include both in a diary.

Migraine can involve throbbing head pain, feeling or being sick, and sensitivity to light or sound. Some people also experience aura: warning symptoms such as flashing lights, zigzag lines or tingling. Describe what happens rather than assuming that any visual change is aura.

Aura changes the contraception conversation

If you have ever had migraine aura, tell your contraceptive prescriber. The NHS lists it among conditions that can make the combined pill unsuitable. ACOG says combined hormonal contraception, including the pill, patch and ring, should not be used if you have migraine with aura.

This advice relates to stroke risk. CDC guidance describes increased ischaemic stroke risk both with combined oral contraceptive use and with migraine aura. New headaches or a marked change in headaches also need assessment. Ask your prescriber which alternative method would suit you.

If aura is newly suspected while you are using a combined method, contact your prescriber promptly for advice about the next step. Ask how to maintain contraception while an alternative is arranged. Changes to prescribed contraception need a clinician’s plan; sudden neurological symptoms need the emergency response below.

Pregnancy and menopause can change attacks

Migraine sometimes improves during pregnancy and often improves after menopause. Some people, though, find migraine worsens or begins around menopause. Discuss a changing pattern with your clinician, even if you think hormones explain it.

Ask your doctor to review migraine treatment if you are pregnant or planning pregnancy. If you are breastfeeding, ask which medicines are suitable then too. A migraine attack during pregnancy or soon after birth needs urgent advice, even if you have had migraine before.

What to put in a migraine diary

Record when the headache began, what was happening around that time and your period dates. Include attacks outside the period window. A migraine diary can help explore triggers and the relationship with bleeding; it gives you and your clinician a record to discuss.

You might also write down how the attack affected work or sleep, any visual or sensory symptoms, and what treatment you used. A short description in your own words is enough to begin. Ask the clinician what extra detail would help them review the pattern.

Treatment can include medicines for an attack, such as triptans or medicines for sickness, and medicines to help prevent attacks. Your pharmacist, GP or doctor can advise on suitability. Regular meals, hydration and sleep are among the habits the NHS suggests alongside care.

When to get urgent help

Call 999 now (UK), 911 (US), or your local emergency number for sudden face drooping, arm or leg weakness or speech problems, or a sudden extremely painful headache. Call too for headache with loss of vision, blurred or double vision, drowsiness, confusion, a seizure, a very high temperature with a stiff neck, or after a recent head injury. Get help even if stroke signs stop; do not wait to see how long aura lasts. Do not assume these symptoms are your usual migraine.

Contact your maternity unit now (UK), your obstetric team (US), or your local maternity service elsewhere for a severe persistent headache, visual changes, pain below the ribs or sudden swelling of your face, hands or feet during pregnancy or after birth. In the UK, call NHS 111 now if you have recently given birth or cannot reach your maternity unit; elsewhere, seek urgent medical help now if maternity care is unavailable. Do not wait until tomorrow. Emergency signs above take priority.

Ask for an urgent GP appointment or call NHS 111 in the UK, contact your doctor or urgent care in the US, or your local urgent-care service elsewhere if an attack lasts longer than 72 hours, aura lasts longer than 1 hour, or an attack happens during pregnancy or soon after birth.

For worsening or difficult-to-control migraine, or attacks regularly linked to periods, book a GP appointment in the UK or see your doctor in the US or elsewhere. Bring the diary and the names of your medicines and contraception.