Menstrual Migraine: Symptoms, Causes, and Treatment in the UK

Menstrual migraine is a specific type of migraine that affects women in close proximity to their menstrual cycle. According to NICE (National Institute for Health and Care Excellence), up to 50% of women who suffer from migraines report a link between their attacks and their periods. These are not merely "bad headaches"; they are neurological events that can be significantly more debilitating than migraines occurring at other times of the month.

There are two primary classifications: Pure Menstrual Migraine, which occurs exclusively during the menstrual window, and Menstrual-Associated Migraine, where attacks happen during the period but also at other times due to triggers like stress, diet, or sleep deprivation.

The primary cause of menstrual migraine is the natural drop in the hormone oestrogen. Just before your period starts, oestrogen levels plummet to signal the shedding of the uterine lining. This withdrawal effect is thought to sensitise the trigeminal nerve and affect serotonin levels in the brain, triggering a migraine cascade.

Other factors that can exacerbate these hormonal shifts include:

• Starting or stopping the combined oral contraceptive pill.
• Fluctuations during the perimenopause.
• The release of prostaglandins during menstruation, which can increase inflammation and pain sensitivity.

Menstrual migraines typically present as a severe, throbbing pain, usually on one side of the head. In the UK, the NHS recommends keeping a headache diary for at least three months to confirm the diagnosis. You should note the date your period starts and the specific days you experience migraine symptoms.

Key symptoms include:

• Intense pulsing or throbbing headache.
• Nausea and occasionally vomiting.
• Increased sensitivity to light (photophobia) and sound (phonophobia).
• Fatigue and irritability.

Interestingly, menstrual migraines are less likely to be preceded by an 'aura' (visual disturbances) compared to non-hormonal migraines.

Standard over-the-counter (OTC) options like paracetamol or ibuprofen are often insufficient for menstrual migraines. UK clinical guidelines suggest a tiered approach to treatment:

Acute Treatment

If OTC medications fail, triptans (such as sumatriptan or rizatriptan) are the gold standard. These work by mimicking serotonin and narrowing blood vessels around the brain. For menstrual attacks, a GP might recommend combining a triptan with a non-steroidal anti-inflammatory drug (NSAID) like naproxen for better efficacy.

Preventive Treatment

For women with predictable cycles, 'mini-prophylaxis' may be used. This involves taking medication like naproxen or a triptan for a few days starting just before the expected period. In other cases, hormonal treatments like the desogestrel progestogen-only pill may be prescribed to stabilise hormone levels and prevent the oestrogen 'dip'.

If your periods are being overshadowed by debilitating headaches that prevent you from working or caring for your family, it is time to seek professional advice. You can speak to a GP online to discuss your symptoms from the comfort of your home.

An online GP consultation is particularly useful for:

• Reviewing your headache diary to confirm a hormonal pattern.
• Discussing the suitability of triptans or other prescription-only medicines.
• Adjusting your current contraception if it is suspected to be a trigger.
• Obtaining a private prescription for specialised migraine relief not available over the counter.

While medication is often necessary, lifestyle adjustments can help lower your overall 'migraine threshold'. Maintaining a consistent routine is vital for migraine sufferers in the UK. This includes:

• Sleep Hygiene: Going to bed and waking up at the same time every day, even on weekends.
• Hydration: Dehydration is a major trigger; ensure you drink plenty of water throughout your cycle.
• Stable Blood Sugar: Eat small, frequent meals rather than large, infrequent ones to avoid glucose spikes and dips.
• Stress Management: Practising mindfulness or yoga may reduce the frequency of attacks triggered by cortisol.