Menstrual migraine: attacks linked to your period and how they are treated

Migraine is a condition that causes a set of symptoms known as a migraine attack. The NHS describes the main symptoms as a throbbing headache, often on one side of the head and worse with movement, feeling or being sick, and being very sensitive to light and sounds. Some people also get aura, such as zigzag lines or flashing lights, numbness or tingling, dizziness or difficulty speaking, which should not last longer than an hour.

Menstrual migraine is the name for attacks that fall around menstruation. The NHS says that having your period is one of the triggers some people find can cause migraine attacks, along with anxiety and depression, stress and tiredness, skipping meals and too much caffeine. It is not a separate disease: it is migraine with a predictable timing.

Because periods are predictable, the pattern can be useful. It allows a person and their doctor to plan treatment around the days when attacks are most likely.

NICE's headache guideline gives a working definition: suspect menstrual-related migraine if migraine occurs predominantly between 2 days before and 3 days after the start of menstruation in at least 2 out of 3 consecutive menstrual cycles. It advises diagnosing it using a headache diary for at least 2 menstrual cycles.

The guideline says that if a diary is used, the person should record, for a minimum of 8 weeks, the frequency, duration and severity of headaches, any associated symptoms, all prescribed and over-the-counter medicines taken, possible triggers and the relationship of headaches to menstruation. The NHS also suggests keeping a migraine diary to help work out what might trigger attacks.

• The date each attack starts and how long it lasts.

• How severe it is and which symptoms you have, including any aura.

• Every medicine you take and when.

• The first day of each period, so that timing can be compared.

• Possible triggers such as missed meals, poor sleep, stress or caffeine.

The NHS says treatment for the symptoms of a migraine attack includes painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and medicines that stop you feeling or being sick, and that if you take painkillers you should take them as soon as your headache starts. It warns to try not to take painkillers for more than 2 days a week, as this can cause more headaches and make migraine harder to treat.

NICE advises offering combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol, for acute treatment of migraine, taking into account the person's preference, other conditions and risk of adverse events. It also advises not offering ergots or opioids for acute treatment of migraine, and explaining the risk of medication overuse headache.

For people whose attacks reliably follow the period and do not respond adequately to standard acute treatment, NICE says to consider treatment with frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg, twice or three times a day) on the days migraine is expected. NICE notes that in June 2025 this was an off-label use of those medicines, meaning it is outside their licensed use, which a prescriber should explain.

The sources used here do not describe other period-specific approaches in detail. For people with frequent attacks across the whole month, preventive treatment may be discussed. The NHS lists medicines that help prevent migraine attacks, such as beta blockers, antidepressants and medicines for epilepsy, along with acupuncture, relaxation techniques and CBT, and vitamin B2.

NICE says not to routinely offer combined hormonal contraceptives to women and girls who have migraine with aura. Anyone with aura who is considering the combined pill, patch or ring should discuss this with a doctor or nurse.

For preventive treatment, NICE says topiramate should not be used for migraine prevention in pregnancy, or in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled, including highly effective contraception. For acute treatment in pregnancy it says to offer paracetamol, and to consider a triptan or an NSAID after discussing the need and risks, and to seek specialist advice if preventive treatment is needed during pregnancy.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if a migraine attack has lasted longer than 72 hours, aura symptoms last longer than 1 hour at a time, or you are pregnant or have just had a baby.

It says to call 999 if you or your child has a headache that came on suddenly and is extremely painful, problems speaking or remembering things, loss of vision or blurred or double vision, drowsiness or confusion, a seizure, a very high temperature with symptoms of meningitis, weakness in the arms or legs on one side of the body or one side of the face, or a recent head injury.

The NHS says most people find their migraine attacks slowly get better as they get older. In women, migraine often gets better after the menopause and sometimes improves in pregnancy. It also says migraine cannot be cured, but treatment can help manage the symptoms and prevent attacks.

Because hormonal changes at perimenopause can disturb the pattern for a time, a diary remains useful through midlife.

On the NHS, a GP can confirm the diagnosis, review a diary, prescribe acute and preventive treatment and refer to a specialist if treatments are not working. The NHS says that if none of the treatments help, or they are getting worse, you may be referred to a specialist for further tests and treatment.

Some people choose private neurology or headache clinics, often to be seen sooner. The same principles apply: a diary, an acute plan, and a preventive plan if needed.