It had been happening every two weeks, like clockwork, for five months.
The worst attacks involved sharp, blinding pain that seared up the back of my head, along with nausea, fatigue and light sensitivity. It would go on for hours; sometimes the only solution was sleep.
Migraines and other migraine-related symptoms plagued me daily. The more mild episodes were less painful, but still frustratingly stubborn: Migraines arriving in the form of aching sinus headaches not cured by any over-the-counter (OTC) pain reliever or decongestant.
Then, for two weeks, I would have virtually no symptoms – until it started all over again.
After several months, I finally opened up my calendar, determined to figure out what was triggering them. As I scrutinised the dates of my migraine episodes, I started to connect the dots. Why did I have symptoms every day for those particular weeks in December, and then not again until January? And why did that pattern repeat itself every month?
That’s when it clicked: My period was the trigger.
My husband and I practice fertility awareness for our family planning needs, so I know the ins and outs of my cycle like the back of my hand. Whenever my period started, so did the migraines; whenever I ovulated, they disappeared. I talked to my primary physician, who agreed that my migraines weren’t random – they were menstrual.
What are menstrual migraines?
Migraines triggered by hormone fluctuations in a woman’s monthly cycle are considered menstrually-related migraines (MRM), which the National Institutes of Health classifies as any migraine episode that occurs up to two days before the onset of a period and three days after, for at least two out of three periods.
“Some studies have identified that about 70% of women with migraine have MRM, while others have shown more conservative numbers of 40 to 50%,” says Dr Jelena Pavlovic, attending neurologist and assistant professor at New York’s Montefiore Health System and American Headache Society member.
“But menstrual migraine is often underreported and under-diagnosed because, in many women, the attacks often start prior to the onset of bleeding and/or do not last the whole menstrual period.”
Why does menstruation have the power to trigger migraines in so many women? Blame oestrogen.
“Menstrual migraine is commonly thought to be ‘triggered’ by the late-luteal phase [or premenstrual] drop in oestrogen,” says Dr Pavlovic.
Since my migraines start with menstruation but continue for nearly two weeks, there are likely other common triggers causing me to experience migraines during a time when I’m particularly susceptible to them (oestrogen levels surge around ovulation, which likely explains why I find relief at that point in my cycle).
But menstruation remains my initial trigger – which means it has also been the key to figuring out how best to treat my migraines.
Menstrual migraine treatments
There are no specific treatment options identified solely for MRM, but a combination of traditional migraine treatments, alternative therapies and hormone-related strategies can be effective.
‘I’m still figuring out what works for my migraines’
It’s been more than a year of trial and error so far.
I know that a large glass of water followed by a cup of caffeinated coffee first thing in the morning does wonders to stave off many of my symptoms. If a migraine develops anyway, I take a Triptan; if I wake up with one already in progress, Excedrin Migraine is the fastest and most reliable option.
I’ve also started taking a daily dose of chelated magnesium, though I’ve struggled to find an effective amount that doesn’t upset my stomach.
But ultimately, identifying my migraines as menstrually related was the most valuable thing I’ve done. I’m not at the mercy of my migraines as much as I was before: I know what’s causing them, when they’ll start and (thankfully) when they’ll end.
For a condition where prevention remains one of the most useful treatment strategies, that knowledge is power.