Migraine attacks related to menstruation are thought to be linked to the changes in hormone levels that occur around that time of the month, and because of that, they are sometimes referred to as hormonal headaches. “It’s very common for women to get migraine around their menstrual cycle, and we believe it’s because of the drop in estrogen,” says Nada Hindiyeh, MD, a headache specialist and researcher at Stanford Health Care in Palo Alto, California. “As the cycle is started, that’s a big trigger for migraine.”

There are several types of migraine, and a subset of migraine is menstrual migraine, which, simply stated, is when a person has migraine attacks only around menstruation, says Dr. Hindiyeh. “There is also menstrually related migraine, which means that although you certainly get migraine around your monthly cycle, you’ll also get migraine attacks at other times of the month,” Hindiyeh says. Most women who have migraine attacks around the time of menstruation have menstrually related migraine, according to Hindiyeh. “Their menstrual cycle will certainly be a trigger, but they also have other triggers or other times when they’ll get migraine [attacks],” says Hindiyeh.

Menstrual Migraine Is Tough to Treat

“Menstrual and menstrually related migraine can be the hardest kind of migraine to treat. [Attacks] can be pretty severe, they can last several days, and they can be quite debilitating,” she says. Even if you have migraine attacks only around the time of your period, for many women that may still mean five days or more a month, says Hindiyeh. “In that case, it’s really time to talk to your doctor about daily preventive treatment options for migraine,” she says. Generally speaking, there are many treatment options for the prevention of migraine and menstrual migraine, says Hindiyeh. Here’s a rundown of the top medications and lifestyle modifications that can help reduce the frequency and severity of menstrual and menstrually related migraine attacks.

1. Triptans Can Play a Preventive Role

Triptans are acute medications that are taken when a person feels a migraine attack coming on, according to Migraine Again. But there are certain types of triptans that are longer acting, which make them useful in preventing a migraine attack or making it less severe, says Hindiyeh. “Your shorter-acting triptans such as sumatriptan (Imitrex) and rizatriptan (Maxalt) typically have a half-life of about four hours,” she explains. The half-life of a drug is the length of time required for the concentration of that drug to decrease to half its starting dose in the body, according to an article in StatPearls. “There are also triptans that have a longer half-life. For example, frovatriptan (Frova) has a half-life of 26 hours, and naratriptan (Amerge) has a half-life of six to eight hours. These longer-acting ones can often be used as a ‘mini-prophylaxis’ right around your period,” she says. “If you know your period is a big trigger for a migraine attack, you can start taking one of those longer-acting triptans a couple of days before your period on a schedule, either every day or twice a day for a few days in row, depending on the medication. This can help prevent the migraine attack from getting so bad,” says Hindiyeh. The American Headache Society specifically recommends frovatriptan “for short‐term preventive treatment of menstrual migraine.”

2. NSAIDs Are Another Option for Prevention

Nonsteroidal anti-inflammatory drugs, or NSAIDs, such naproxen (Aleve), can also be used strategically for menstrual migraine as a prophylaxis in a similar strategy to triptans, says Hindiyeh. According to the headache specialist Vincent T. Martin, MD, writing for the American Headache Society, 550 milligrams (mg) of Aleve taken twice day for six days before to seven days after menstruation has demonstrated effectiveness in the prevention of menstrual migraine. A meta-analysis published in Neurology examined 15 studies that looked at NSAIDs and complementary therapies such as various herbal remedies and concluded that using NSAIDs to prevent episodic migraine attacks is “probably effective.” But their use specifically for preventing menstrual migraine wasn’t addressed. If you think you might want to try taking an NSAID to prevent menstrual migraine attacks, be sure to discuss this plan with your healthcare provider. There are potential risks to taking NSAIDs, including an increased risk of heart attack and stroke, per the U.S. Food and Drug Administration, as well as gastrointestinal bleeding and ulcers.

3. Oral Contraceptives May Reduce Menstrual Migraine Frequency

“There is some evidence to suggest that certain types of oral contraceptive pills can actually reduce the frequency of menstrual migraine and menstrually related migraine,” Hindiyeh says. This doesn’t apply to all kinds of oral contraception, so you should talk with your gynecologist, primary care doctor, or neurologist about which ones you’d want to consider, says Hindiyeh. “There are specific ones that will keep your estrogen level from fluctuating so much,” she says. If you’re considering taking oral contraceptives (also known as the pill) as a means of birth control or to try to improve your migraine symptoms, tell your healthcare provider about your migraine history, says Hindiyeh. While most headache specialists agree that hormonal birth control is safe for most women with migraine, there are cases where it can elevate the risk of stroke, cardiovascular disease, or deep vein thrombosis (blood clot), according to the American Migraine Foundation. Women who have migraine with aura, in particular, are advised to talk to their doctors about any additional risk factors for stroke or cardiovascular disease that they may have.

4. Self-Care Makes a Difference in Migraine Frequency

If you have menstrual migraine, it’s especially important to take care of yourself and try to decrease your stress level around your period, says Hindiyeh. “Keep a regular sleep schedule, which means waking and going to bed at around the same times every day. Don’t skip meals, try to eat protein with every meal, and do aerobic exercise every day for about 20 to 30 minutes,” she says. “Making these habits a priority will help you decrease the frequency and severity of your migraine attacks,” says Hindiyeh.

5. Daily Magnesium Has a Preventive Effect

“I really like magnesium as a natural supplement to take every day to help prevent menstrual migraine,” says Hindiyeh. There is evidence to support using magnesium, though the mechanism of action, or the “why” behind how it improves migraine, is not totally understood, she says. “It could be stabilizing cells or decreasing hyperexcitability or neuronal firing, but that’s all theoretical at this point,” she adds. A review published in the February 2018 issue of Headache that examined five clinical trials of magnesium for migraine prevention concluded that high doses of magnesium citrate “seems to be a safe and cost efficient strategy.” While the Headache review didn’t address menstrual migraine specifically, the American Migraine Foundation reports that daily oral magnesium supplement has been shown to be effective in preventing menstrually related migraine, especially in women with premenstrual migraine. A variety of types of magnesium supplements can be purchased over the counter. You can learn more about the various types on the website Migraine Again, and remember that it’s always a good idea to talk with your doctor about any supplements you are taking or are interested in taking.

6. Regular Exercise Can Help Prevent Menstrual Migraine

“When we consider all the strategies to prevent migraine attacks, I love it when people choose to make lifestyle modifications that can make a real difference,” says Hindiyeh. “There’s lots of evidence to suggest regular aerobic exercise can work as a preventive medication all on its own, and there are some studies to suggest that yoga and HIIT (high-intensity interval training) can be helpful as well,” says Hindiyeh. A review published in 2020 in Current Pain and Headache Reports identified numerous studies showing that aerobic exercise could reduce migraine frequency, intensity, and duration, with higher-intensity exercise having more benefits. But the author observed that low-impact exercises such as yoga could also have benefits. “Not only can regular exercise help prevent migraine attacks for some people, but also, if the headache is mild, a short bout of exercise can actually help relieve the headache that’s happening,” according to Hindiyeh. On the other hand, overexerting yourself can be a trigger for migraine, especially if you are already having a migraine attack, she says. “One of the cardinal definitions and features of migraine is that normal activity can make you feel worse. If you’re already in the middle of a severe migraine attack, moving around excessively is going to make things worse for you; it’s probably not the best time to go for a jog or do some aerobic activity,” says Hindiyeh. “Beta-blockers, such as propranolol, are commonly used as a daily preventive for migraine. There is lots of evidence to suggest that they can decrease the severity and frequency of migraine,” she says. Exactly how beta-blockers prevent migraine attacks is unknown, according to a review in the journal Neurotherapeutics in April 2018. It could be mainly their effect of blocking the action of the hormones epinephrine (also called adrenaline) and norepinephrine (noradrenaline), which slows the heart and relaxes blood vessels. It may also be related to the way some beta-blockers shut down certain serotonin receptors in the brain and elsewhere in the body. Changes in serotonin levels in the brain have been linked to migraine attacks. But beta-blockers have many other effects in the body, and these are just two of the possibilities for their therapeutic effect on migraine. A position statement from the American Headache Society says the beta‐blockers metoprolol (Lopressor), propranolol, and timolol “have established efficacy and should be offered for migraine prevention,” and the beta‐blockers Tenormin (atenolol) and Corgard (nadolol) “are probably effective and should be considered for migraine prevention.” If beta-blockers aren’t an option for you or don’t reduce your migraine attack frequency, there are several other classes of medications, including anti-epileptic drugs and certain antidepressants, that can be effective preventives, observes Hindiyeh.

8. CGRP Inhibitors Show Promise for Menstrual Migraine

CGRP inhibitors are among the newest drugs approved for the treatment of migraine. There are two types: CGRP monoclonal antibodies, which are given as injections or infusions and are used for migraine prevention, and CGRP receptor antagonists, which are taken as pills and are used either for prevention or acute treatment, depending on the particular product. Both target calcitonin gene-related peptide (CGRP), a protein involved in the transmission of pain. So far, not a lot of studies have looked at whether these drugs are effective at preventing or treating menstrual migraine, but one recent study of CGRP monoclonal antibodies had promising results. As reported in December 2021 in the journal Pain and Therapy, 40 women were given CGRP monoclonal antibody injections over six months. Most of the participants took erenumab (Aimovig), but a few used galcanezumab (Emgality) or fremanezumab (Ajovy). After six months, the researchers saw a significant reduction in the frequency, duration, and intensity of migraine attacks occurring during the perimenstrual window — defined as two days before the onset of menstruation and continuing through three days after onset. In addition, a much higher percentage of the women in the study responded to migraine painkillers within two hours of taking them. The researchers concluded that CGRP monoclonal antibodies “could represent a safe and effective preventive therapeutic strategy” for menstrual migraine. Hindiyeh cautions, however, that most insurance companies won’t cover a CGRP drug until a person with migraine has tried a certain number of oral preventive medications first, without good results. In addition, she says, “With certain CGRP antibodies, specifically Aimovig, I would consider avoiding them in anyone who has hypertension or constipation, as it may make these conditions worse.”

9. Nerve Stimulation May Be an Option

For women who would like an alternative to pharmaceuticals, nerve stimulation devices may be worth a try. Five such devices are approved to treat migraine — some just for acute treatment, and some for both acute and preventive care. Most haven’t been studied specifically for menstrual migraine, but at least one study found that the GammaCore device, which stimulates the vagus nerve via the neck, has a prophylactic, or preventive, effect on menstrual and menstrually related migraine when used daily starting three days before the expected onset of menstruation through three days after the end of menses. Use of the device led to a significant decrease in the number of migraine days per month as well as a reduction in the use of analgesics (pain relievers).