How to Take Care of Yourself If You Get Migraines During Your Period

Ah, menstruation—giver of stained underwear, unrelenting cramps, and for some people, migraine attacks. If you feel a vice-grip around your skull right around the time your uterus decides it’s time for a deep cleaning, it’s probably not a coincidence.

“Menstruation is a very common trigger of migraine attacks in women,” Addie Peretz, MD, clinical assistant professor in the department of neurology and neurological sciences at Stanford University School of Medicine, tells SELF. Migraine is a complex neurological condition that essentially makes your brain really sensitive to certain triggers, which can lead to painful (and potentially debilitating) attacks. For some people, migraine triggers include certain foods, a lack of sleep, or stress. For others, the drop in estrogen that occurs right before their period starts can bring on an attack, she says.

If you have menstrual migraine attacks, you already know they really suck. “Migraine attacks associated with menstruation tend to last longer, be more disabling, and are less treatment-responsive than non-menstrual migraine attacks,” Dr. Peretz says.

So, what can you do about it? Menstrual migraine treatment can be broken up into three general buckets: acute treatment, for when you’ve already got a migraine and are trying to get relief; mini preventive treatment, which focuses on preventing a migraine in the days before your cycle; and continuous preventive treatment, which might be appropriate if you have attacks at other points during the month or if your migraines aren’t responding to mini prevention.

“The overall goal is to decrease the intensity and the frequency of the migraine attacks so they have as little impact on your day-to-day functioning as possible. That’s a universal goal of migraine treatment, but especially true during the menstrual cycle,” Mason Dyess, DO, a neurologist and headache medicine specialist at Ochsner Medical Center in New Orleans, tells SELF.

Ready to get some relief? Here’s what you can do—because PMS is already bad enough on its own.

Track your menstrual cycle and your migraine symptoms.

It’s important to figure out exactly when in your cycle you’re experiencing migraine attacks, how bad they tend to be, and whether they’re also happening outside of your period week. “Being able to pick up on patterns about when your migraine attacks are happening most often during the month is extremely powerful for headache providers,” Dr. Dyess says. “That can help us get a treatment strategy together that's uniquely crafted to you and your triggers.”

Consider tracking your menstrual cycle and headache cycle, whether that’s with a physical calendar, a period app, or the Notes app on your phone. The sky’s the limit for how much information you can record, but there are a few key things to cover. “At a minimum, I would suggest tracking whether you had a headache each day, the severity of the pain, whether you took medication to alleviate your pain, and when your period started and ended,” Dr. Peretz says. This can help you and your doctor confirm if attacks coincide with typical hormone dips during your monthly cycle.

If you need contraception, some birth control can help reduce menstrual migraine symptoms.

Since a change in estrogen levels can trigger a migraine attack, one strategy is to try to minimize that hormonal dip. If this is the case for you, the pill, vaginal ring, patch, and other hormonal contraceptives may help change your migraine patterns. “Some patients go on birth control to make their menstrual cycles more predictable, or to eliminate them, which can sometimes reduce overall migraine burden,” Dr. Dyess explains.

For people who experience migraine with aura, though, certain birth control methods are off the table. “Taking estrogen-containing medications is often not recommended due to an increased risk of stroke associated with migraine with aura and concurrent use of medication with estrogen,” Dr. Peretz says. (Aura is a term used to describe visual, sensory, or other neurologic symptoms that can occur during a migraine attack. Examples include blind spots in your vision, flashing lights, and numbness or tingling in the face and hands, according to the Mayo Clinic.)

Progestin-only birth control, known as the mini pill, is still an option for people who have migraine with aura, according to the Mayo Clinic. How well these pills work for menstrual migraine is still being investigated, Dr. Peretz says, but some preliminary studies suggest progestin-only birth control pills can reduce the number of headache days and severity of migraines, possibly by preventing ovulation or changing pain pathways in the brain.1

If you only get migraine attacks around your period, “mini” preventive treatments might be enough.

So you’ve done your period tracking and determined, yes, you only get migraine attacks in the days directly surrounding your period. In that case, you might be able to treat them on a short-term basis.

“Mini prevention involves using medication for a short time period to prevent migraine attacks around menstruation,” says Dr. Peretz. Usually, that means taking triptans or pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen sodium, and aspirin, or acetaminophen. To use these treatments as a mini-preventive, they are “typically taken two days prior to menstruation and continued for three to five consecutive days,” Dr. Peretz explains.

Of course, since the timing is so important, this method is best suited to people who have regular cycles. And even if that’s true for you, it’s important to keep track of how often you’re taking them outside of those mini-preventive windows of time. “Frequent use of these medications can increase the risk of developing medication overuse headaches,” Dr. Peretz says. That’s the last thing you want. If you find your headaches are becoming more severe or more frequent, talk to your doctor about whether another strategy might be a better or safer option.

You may also benefit from long-term preventive treatment.

Just because your migraine attacks mostly hit around your period doesn’t mean that’s the only time you can take action. “There are some patients whose migraines are so debilitating around the time of their menstrual cycle that we actually choose to treat them for migraine throughout the month with preventive medicine,” Dr. Dyess says.

There aren’t special medications for menstrual migraine, but general migraine medication tends to work to help prevent and lessen the intensity of attacks around your period. These medications can include tricyclic antidepressants, blood pressure medications, antiseizure drugs, and calcitonin gene receptor peptide (CGRP) antagonists, among others, as SELF has previously reported. Your doctor can help you figure out which drug or combination of drugs gives you the most headache-free days.

Keep “rescue” medication on hand.

If those don’t cut it—or you’re taking them too frequently and experiencing overuse headaches—your doctor can prescribe a rescue medication. Common types that help minimize pain include triptans, dihydroergotamine (which also comes as a nasal spray), gepants, ditans, as well as antiemetics, which can help with nausea and vomiting often brought on by migraine attacks. These can be used in addition to long-term preventive medications or simply on their own if you and your doctor determine that’s what’s best for you.

Take some time for self-care.

You probably don’t need to be told to do this, but if your migraine is making you light sensitive, retreat to a quiet, dark room to ease the pain, per the Mayo Clinic. Sleep is A-OK, too, if the pain isn’t interfering with that.

Once you’re in the throes of a migraine, another relief option is to hold ice to the painful area of your head or neck (covered with a cloth to protect your skin). Dr. Dyess says many of his patients have bought ice “caps” that they keep in their freezer. “A lot of people find those especially helpful during menstrual migraine attacks,” he says. The treatment likely works in the short term because ice has a numbing effect, according to the Mayo Clinic.

Don’t forget to take care of your other period symptoms, too. Doubling over with cramps during a migraine attack will only make you feel worse. You can try putting a hot pad on your abdomen for some relief, and generally trying to rest your body. Any OTC pain relievers you take for your head pain should help with cramps, too.

Dealing with a migraine around your period is a lot to take in, but some combination of the methods above is likely to make that time of the month a lot better. “Most patients are able to find effective treatment plans for migraine,” Dr. Dyess says, “whether it's menstrually centered or not.”A rescue medicine, also known as an abortive medicine, doesn’t prevent a migraine attack but can help stop one from progressing. The key is taking it at the first sign of an impending attack. Common over-the-counter abortive medicines include ibuprofen, acetaminophen, aspirin, and medications that combine NSAIDs and caffeine.