How do I manage monthly migraines around my period?

Question

Hello doctor,

I am a 31-year-old woman who experiences migraine attacks almost every month, particularly before my period. The pain usually affects one side of my head and is sometimes accompanied by nausea and sensitivity to light. While painkillers provide some relief, the headaches tend to recur.

My doctor recently mentioned preventive injections, but I am a bit concerned about their safety, especially since I am planning to get pregnant in the near future. I would also like to know whether stress or skipping meals can trigger or worsen migraines, and if hormonal birth control might help manage them or potentially make them worse.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I completely understand your concerns.

Your symptoms are consistent with menstrual or hormonally triggered migraines, which are quite common among women of reproductive age. Here is a breakdown of what might be happening and how you can manage it:

Causes and triggers: Fluctuations in hormone levels, especially the drop in estrogen just before your period, can trigger migraines. Other common factors, such as stress, skipping your meals, dehydration, lack of sleep, or changes in caffeine intake, can make your migraine worse. Maintaining regular routines with meals, hydration, sleep, and stress management can help reduce your attacks.
Preventive injections: Your doctor may be referring to CGRP monoclonal antibody injections (such as Aimovig, Ajovy, or Emgality). These treatments are effective for frequent migraines and are generally considered safe; however, they have not yet been approved for use during pregnancy due to limited long-term safety data. If you are planning to conceive soon, it is usually best to focus on your lifestyle adjustments or short-term oral preventive medications that can be safely discontinued before pregnancy.
Hormonal birth control: Hormonal contraception can either improve or worsen your migraines, depending on the pattern. If migraines occur mainly before your period, low-dose hormonal pills or continuous hormonal regimens (without the placebo week) may help reduce their episodes. However, if you experience migraines with aura (such as visual disturbances or flashing lights), combined estrogen-containing pills should be avoided because they can increase the risk of stroke. In that case, progestin-only options are considered safer.
Practical steps: Keeping a migraine diary can be very helpful for you to track triggers, menstrual cycle timing, and your response to treatments. Aim to eat regularly, stay well hydrated, get seven to eight hours of sleep each night, and manage your stress through relaxation techniques, mindfulness, or yoga.

I hope this helps.

Kindly revert if there are any queries.

Thank you.

How do I manage monthly migraines around my period?

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