Headache and late period: Headache And Missed Or Late Menstrual Period

31.08.202305.07.2023 by alexxlab

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Hormone headaches – NHS

Many women experience headaches caused by changes in their hormones.

According to the National Migraine Centre, more than half of women who get migraines notice a link with their periods.

These so-called “menstrual migraines” tend to be particularly severe.

Migraine is most likely to develop in either the 2 days leading up to a period or the first 3 days during a period. This is because of the natural drop in oestrogen levels at these times.

The attacks are typically more severe than migraines at other times of the month and are more likely to come back the next day.

Periods are not the only trigger of hormone headaches.

Other causes include:

the combined pill (combined oral contraceptive pill) – some women find their headaches improve while they’re on the pill, but others report more frequent attacks, especially in the pill-free week, when oestrogen levels drop
the menopause – headaches usually worsen as you approach the menopause, partly because periods come more often and partly because the normal hormone cycle is disrupted
pregnancy – headaches can get worse in the first few weeks of pregnancy, but they usually improve or stop completely during the last 6 months; they do not harm the baby

Signs of hormone headaches

It’s worth keeping a diary for at least 3 menstrual cycles to help you check whether your migraines are linked to your periods.

If they’re linked, a diary can help to pinpoint at what stage in your cycle you get a migraine.

The Migraine Trust website has a downloadable headache diary, which may be a useful tool.

Self-help tips for hormone headaches

If keeping a diary reveals that your headaches develop just before your period, you can try these tips to help prevent a migraine:

Eat small, frequent snacks to keep your blood sugar level up. Missing meals or going too long without food can trigger attacks. Have a small snack before going to bed, and always eat breakfast. Here are some healthy breakfast recipes
Have a regular sleep pattern, and avoid too much or too little sleep. Get a good night’s sleep with 10 tips to beat insomnia
Avoid stress. If this proves difficult, find ways to deal with stress, such as taking regular exercise and using relaxation strategies. Use these 10 stress busters

Treatments for hormone headaches

Migraine treatments

Your doctor can also prescribe migraine medicines for you to take around the time of your period.

These do not contain hormones, but they can help stop the headaches developing.

They include tablets called triptans and a type of painkiller called mefenamic acid.

Continuous contraceptive pills

Talk to your doctor if you think your contraceptive pills are making your migraines worse.

If you have headaches during the days you do not take the pills, you can avoid the sudden fall in oestrogen by taking several packs continuously without a break.

Find out more about the combined contraceptive pill

Hormone replacement therapy

The hormone changes that happen as women approach the menopause mean that all types of headache, including migraines, become more common.

Hormone replacement therapy (HRT) can be helpful to treat hot flushes and sweats.

But if you have migraines, it’s best to use patches or a gel, as these types of HRT keep hormone levels more stable than tablets and are less likely to trigger migraines.

Oestrogen therapy

If you have regular periods, a doctor can prescribe an oestrogen gel or patch, which you use before your period is due and for a few days during your period.

But these are not commonly prescribed for hormone headaches.

Page last reviewed: 23 September 2021
Next review due: 23 September 2024

Why It Happens and How to Prevent It

Headache Before Period: Why It Happens and How to Prevent It

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Medically reviewed by Deborah Weatherspoon, Ph. D., MSN — By Crystal Raypole on May 3, 2019

If you’ve ever had a headache before your period, you’re not alone. They’re one of the most common symptoms of premenstrual syndrome (PMS).

Hormonal headaches, or headaches linked to menstruation, may result from changes in the levels of progesterone and estrogen in your body. These hormonal changes can have an impact on serotonin and other neurotransmitters in your brain, which can lead to headaches.

Read on to learn more about premenstrual headaches and how to treat them.

A headache before your period can be caused by many things, the two big ones being hormones and serotonin.

Hormones

Premenstrual headaches are usually caused by the decrease in estrogen and progesterone that happens before your period begins.

While these hormonal changes happen in all people who menstruate, some are more sensitive to these changes than others.

Hormonal birth control pills can also cause premenstrual headaches in some people, though they improve symptoms for others.

Serotonin

Serotonin also plays a role in headaches. When there’s less serotonin in your brain, blood vessels can constrict, leading to headaches.

Before your period, the levels of serotonin in your brain may decrease as estrogen levels decrease, contributing to symptoms of PMS. If your serotonin levels decrease during your menstrual cycle, you’re more likely to experience headaches.

Anyone who menstruates can experience drops in estrogen and serotonin before their period. But some may be more prone to developing headaches in response to these drops.

You might be more likely to get headaches before your period if:

you’re between the ages of 18 and 29
you have a family history of hormonal headaches
you’ve entered perimenopause (the years before menopause begins)

Getting headaches around the time you expect your period to start can sometimes be a symptom of pregnancy.

If you’re pregnant, you won’t get your usual period, but you might experience some light bleeding.

Other early signs of pregnancy include:

nausea
mild cramps
fatigue
frequent urination
mood swings
increased sense of smell
bloating and constipation
unusual discharge
darkened or larger nipples
sore and swollen breasts

Keep in mind that if your headache is an early pregnancy symptom, you’ll likely have at least a few of these other symptoms as well.

If you get headaches before your period, several things may provide pain relief, including:

Over-the-counter pain relievers. These include nonsteroidal anti-inflammatory drugs, such as acetaminophen (Tylenol) or ibuprofen (Advil), and aspirin.
Cold compresses or ice packs. If you’re using ice or an ice pack, make sure to wrap it in a cloth before applying it to your head. Learn how to make your own compress.
Relaxation techniques. One technique starts by beginning in one area of your body. Tense each muscle group while breathing in slowly, then relax the muscles as you breathe out.
Acupuncture. Acupuncture is believed to help relieve pain by restoring imbalances and blocked energy in your body. There isn’t much evidence to back up its use as a treatment for premenstural headaches, but some people find that it offers relief.
Biofeedback. This noninvasive approach aims to help you learn to control bodily functions and responses, including breathing, heart rate, and tension.

If you regularly get headaches before your period, it might be worth taking some preventive measures.

These include:

Physical activity. Getting at least 30 minutes of aerobic exercise, three or four times a week, can help prevent headaches by releasing endorphins and increasing serotonin levels.
Preventive medications. If you always get a headache around the same time, consider taking NSAIDs in the day or two leading up to this time.
Dietary changes. Eating less sugar, salt, and fat, especially around the time your period is supposed to begin, may help prevent headaches. Low blood sugar can also contribute to headaches, so make sure you’re eating regular meals and snacks.
Sleep. Try to prioritize getting seven to nine hours of sleep most nights. If you can, going to bed and getting up at the some time more often than not can also help to improve the quality of your sleep.
Stress management. Stress often contributes to headaches. If you’re experiencing a lot of stress, consider trying meditation, yoga, or other methods of stress relief to relieve headache-causing tension.

It may also be worth asking your healthcare provider about hormonal birth control if you don’t currently use any. Even if you do already use hormonal birth control, there may be better options to deal with your headaches.

For example, if you take birth control pills and tend to get a headache around the time you start taking placebo pills, taking only active pills for several months at a time may help.

If nothing seems to be helping your premenstrual headaches or they become severe, you may be experiencing migraine attacks, not headaches.

Compared to a headache, migraine tends to cause more of a dull, aching pain. Eventually, the pain may start to throb or pulse. This pain often occurs on only one side of your head, but you might have pain on both sides or at your temples.

Usually, migraine attacks cause other symptoms as well, including:

nausea and vomiting
light sensitivity
sound sensitivity
an aura (light spots or flashes)
blurry vision
dizziness or lightheadedness

Migraine episodes typically last for a few hours, though a migraine attack can persist for up to three days.

If you think you might be experiencing migraine before your period, make an appointment with your healthcare provider.

Learn more about hormonal migraine attacks, including how they’re treated.

It’s not unusual to get a headache before your period starts. This is usually due to changes in levels of certain hormones and neurotransmitters.

There are several things you can try doing for relief, but if they don’t seem to be working, make an appointment with your healthcare provider. You might be dealing with migraine or require additional treatment.

Last medically reviewed on May 3, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

About hormone imbalance: How does my hormone cycle work?
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Headache. (n.d.).
migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/headache
Mayo Clinic Staff. (2017). Symptoms of pregnancy: What happens first?
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Menstrual migraine. (2007).
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Migraine and the contraceptive pill. (n.d.).
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Premenstrual syndrome (PMS). (2015).
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Young SN. (2007). How to increase serotonin in the human brain without drugs.
ncbi.nlm.nih.gov/pmc/articles/PMC2077351

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Medically reviewed by Deborah Weatherspoon, Ph. D., MSN — By Crystal Raypole on May 3, 2019

Menstrual migraine: a modern view of the problem | Azimova Yu.E.

There is an obvious relationship between the menstrual cycle and migraines. If before puberty the prevalence of migraine among boys and girls is the same, then after puberty it is higher among girls than boys. According to epidemiological studies, 50-70% of women note the occurrence of migraine in certain phases of the menstrual cycle [1-6]. In 14% of women, migraine develops exclusively during menstruation [6, 7]. This connection is so important that in the International Classification of Headache III (2013) working criteria for menstrual migraine were identified (Table 1) [8]. According to the criteria, menstruation is considered endometrial bleeding resulting from a normal menstrual cycle or the withdrawal of exogenous progestogens used for contraception or hormone replacement therapy. The first day of menstruation is day 1, the previous one is day -1, the next day is day 2 (day 0 is not provided). According to the classification, menstrual migraine is divided into “pure” menstrual migraine, in which attacks occur exclusively in the perimenstrual period, and menstrual-associated migraine, in which attacks occur in the perimenstrual period, but can also develop in another phase of the cycle.

Pathophysiology of menstrual migraine

Data from basic research conducted in recent years have made it possible to understand the pathophysiology of menstrual migraine in many ways. Sex hormones (estrogen, progesterone, testosterone) greatly influence brain function. Estrogens can modulate neuronal activity through estrogen receptors, which are widely present in the central nervous system (CNS), especially in the hypothalamus [9].
Estradiol is synthesized in neurons in various areas of the brain that are involved in the pathogenesis of migraine. Thus, the level of estrogens is increased in the thalamus region, which has an increased sensitivity to the conduction of pain stimuli in migraine, the nucleus accumbens, which regulates the provision of the emotional reinforcement mechanism, and the amygdala, which is involved in the development of anxiety and fear [10–13]. By modulating the activity of these regions, estrogens can cause migraine symptoms such as allodynia, mood changes, and eating disorders. In addition, midbrain serotonin neurons that project to the frontal lobes, limbic, diencephalic regions, and spinal cord and regulate both mood and pain conduction contain receptors for both estrogen and progesterone [14]. Polymorphisms of the estrogen gene ESR-1 594G>A and 325C> G increase the risk of migraine by 40–60% [15], and the CYP19A1 rs10046 and CYP19A1 rs4646 aromatase polymorphisms, which catalyze estrogen synthesis, increase and decrease the risk of migraine, respectively [16].
Progesterone is also widely distributed in the CNS and appears to have the opposite effects of estrogen. Thus, progesterone has an anticonvulsant effect [17].
It is assumed that testosterone has anti-migraine activity. Thus, synthetic derivatives of testosterone improve the course of migraine in both men and women [18], apparently through the suppression of spreading cortical depression [19]. In addition, the prevalence of migraine is higher among homosexual men who have low testosterone levels compared to heterosexual men (15.5% and 7.2%, respectively) [20].
Studies of sex hormones in migraine are of undoubted interest. Thus, in patients with “pure” menstrual migraine, compared with healthy individuals, there is an increase in the level of estrogen and progesterone in all phases of the menstrual cycle, especially in the luteal phase [21]. Based on these data, it can be assumed that in migraine there is dysfunction of the hypothalamus, which not only produces sex hormones and cortisol, but also regulates circadian rhythms. This is confirmed by a recent neuroimaging study by A. May, which showed that the “generator” of a migraine attack is a dysfunction of the hypothalamus and its connections with subcortical and stem structures [22]. How can sex hormones be associated with a migraine attack?
The hypothalamus produces gonadotropic releasing hormone, which is released at regular intervals (Fig. 1). The frequency of release of gonadotropic releasing hormone is higher in the follicular phase and the period of ovulation, while the greatest fluctuations in the level of this hormone are noted in the luteal phase [23]. Estrogen regulates the release of gonadotropic releasing hormone on the principle of negative feedback. Gonadotropic releasing hormone regulates the hormonal fluctuations during the cycle – the peak of estrogen in the late follicular phase and the peak of progesterone in the middle of the luteal phase through an increase in the level of luteinizing and follicle-stimulating hormones in the middle of the cycle (day 14). Levels of sex hormones (estrogen and progesterone), as well as their releasing factors – luteinizing and follicle-stimulating hormones fall by the 28th day of the cycle (before menstruation) (see Fig. 1). Further, in the next 7 days, estrogen and progesterone are at a stable low level, while from the 14th to the 28th day of the cycle, hormone levels change in waves. These wave-like fluctuations of sex hormones in the middle of the luteal phase lead to an increase in neuronal excitability. Neuronal excitability increases during estrogen peaks – ovulatory and in the middle of the luteal phase [24].

Estrogens can influence the conduction of pain at all levels: at the level of the dura mater [25], trigeminal nerve [26], trigeminal ganglion [27], trigeminal nucleus [28], thalamus [29], cortical systems [30], as well as descending modulating systems [31]. Data from preclinical studies show that estrogens play an important role in the regulation of trigeminal neuron sensitization through direct activation of the calcitonin gene-related peptide [25]. In a study by B. Barbosa Mde et al. thresholds of pain sensitivity in women were studied in different phases of the menstrual cycle (menstrual, follicular, ovulatory, luteal, premenstrual) [32]. The lowest pain thresholds were observed in the premenstrual phase. Another factor contributing to the development and clinical features of menstrual migraine is the dysfunction of higher centers of pain perception. N. Maleki et al. using functional neuroimaging, women with migraine have been shown to have damage to the parietal cortex (precuneus) and insula, compared with men with the same clinical picture of migraine [33]. Considering that sex hormones can damage neuronal circuits that regulate emotions [34], it can be assumed that different responses to pain stimuli in men and women are associated precisely with damage to these neuronal circuits [35].

Clinical picture of menstrual migraine

Menstrual migraine has clinical features. According to the analysis of the diaries, the most frequent migraine attack in most patients occurs on the 2nd–3rd day of menstruation [36]. Both population-based and clinical studies show that menstrual and menstrual-associated migraine attacks are more intense, longer, more often accompanied by nausea and vomiting, more maladjusted patients and less responsive to treatment [5, 37-39]. Attacks that occur 2 days before the onset of menstruation are at the highest level of intensity. The probability of their higher intensity is 2.1 times higher than that of attacks developing in the first 3 days of menstruation, and 3.4 times higher than that of migraine attacks occurring in other phases of the cycle [40].

Treatment of menstrual migraine

Treatment of menstrual migraine consists of relief of attacks and prevention. For the relief of menstrual migraine, the same drugs can be used as for non-menstrual migraine, but there are certain differences. Since attacks are much more severe and less responsive to therapy, it is recommended to start therapy immediately with triptans. Sumatriptan [38], zolmitriptan [41], olmotriptan [42], rizatriptan [36], naratriptan [36] have been proven to relieve an attack of menstrual migraine. The most studied effects of zolmitriptan. Thus, a randomized, prospective, parallel, double-blind, placebo-controlled study included 579female patients. Relief or significant regression of headache 2 hours after administration was observed in 48% of patients taking zolmitriptan and 27% of patients taking placebo (p<0. 0001) [41]. In this study, zolmitriptan was superior to placebo as early as 30 minutes after dosing.
Preventive therapy for menstrual migraine can be carried out according to the same rules as for non-menstrual migraine, or it can be short-term, that is, it can be prescribed only in the perimenstrual period. Short-term prophylaxis is more appropriate for true menstrual migraine and is considered in cases where triptans are not effective in relieving attacks. The drug for short-term prophylaxis is prescribed 2-3 days before the planned onset of menstruation for 5-6 days. Naproxen has been shown to be effective in a small open-label study [43], but no benefit was found in a double-blind, placebo-controlled study compared to placebo [44]. Several triptans have been shown to work: sumatriptan, zolmitriptan, naratriptan and frovatriptan. The most evidence-based study was with zolmitriptan (Fig. 2). Thus, when taking 2.5 mg of zolmitriptan 3 times a day, the reduction of menstrual migraine attacks by half or more occurred in 58. 6% of patients, and when taking 2.5 mg of zolmitriptan 2 times a day – in 54.7%. Also, when taking zolmitriptan, there was a decrease in the number of attacks of menstrual migraine in three consecutive menstrual cycles (Fig. 3) [45]. Currently, the available Russian drug Migrepam can be recommended for patients with menstrual migraine.

For short-term prophylaxis, estradiol (transdermal gel) at a dose of 1.5 mg, given 2 days before the planned menstruation for 7 days, can also be used [46]. There are data on the effectiveness of taking oral magnesium preparations from the 15th day until the end of menstruation [28].
If patients have menstrual-associated migraine or an irregular cycle, then it is better to use continuous prophylactic therapy with beta-blockers, anticonvulsants, antidepressants. With menstrual migraine, constant prophylaxis with hormonal preparations is also possible. Thus, the use of transdermal contraceptives for 84 days allowed to reduce the number of days with menstrual migraine [46].

The problem of organizing care for patients with menstrual migraine

Patients with menstrual migraine face the lack of competence of gynecologists regarding migraine and the lack of competence of neurologists regarding hormone therapy. The selection of hormonal therapy should be carried out by a gynecologist, taking into account all the characteristics of the patient, and migraine therapy should be prescribed by a neurologist. In addition, 74% of patients with menstrual migraine have concomitant gynecological pathology and require specialist advice [47]. In 2012, a specialized menstrual migraine clinic was established in Denmark. It has been shown that the joint management of patients by neurologists and gynecologists improves the quality of their treatment. Thus, the number of days with migraine decreases from 6 to 3.83 days, the quality of life improves. This approach to the treatment of menstrual migraine can be considered the “gold standard”.

Doctor Savkina explained why her head hurts during menstruation

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menstrual migraine.

March 20, 20237

Source:: iStockphoto

According to various sources, more than half of women report the appearance of various types of headaches in certain phases of the cycle. Approximately 14% of women experience migraine during menstruation – excruciating pain, which is localized mainly in one half of the head.

The very concept of “menstrual migraine” in medical terminology is placed in a separate category. Marina Savkina, leading expert, consultant in laboratory medicine at the CMD Center for Molecular Diagnostics of the Central Research Institute of Epidemiology of Rospotrebnadzor, told Doctor Peter if there are ways to rid yourself of this scourge.

Why does my head hurt during menstruation

Many factors are involved in the development of headaches. Including the woman’s age and history of various illnesses throughout her lifetime. Fluctuating levels of the sex hormones estrogen and progesterone play a key role in the menstrual cycle. They can also influence the development of the problem. In particular, a decrease in the level of estrogen in the blood just before menstruation just causes a migraine.

This is due to the influence of estrogen and progesterone on the biochemical processes in the brain. Often women complain of such malaise before or during menstruation. In addition, estrogens cause mood changes, eating disorders . Their constant level can relieve pain, therefore, in the absence of contraindications, estrogen preparations may be prescribed for some women.

Most often, a migraine attack occurs on the second or third day of the menstrual cycle, it can be accompanied by nausea and vomiting, malaise, dizziness. To understand the connection with the cycle, it is recommended to keep a diary of headaches to identify their exact cause. It also needs to record oral contraceptives, if you drink them, the days of the cycle, ovulation.

Sometimes it makes itself felt with an aura

Some women may experience migraine with aura. This is a special condition, a harbinger of an attack, when other symptoms from the nervous system appear before or after the headache itself, for example flies before eyes, flashes of light, tingling in arms and legs. In such cases, estrogen preparations are undesirable, especially if the woman also smokes.

May improve with pregnancy. And for those women who have not previously encountered such problems, migraine may appear just during this period.

How to understand that it is she?

There are a number of characteristics that can point to menstrual migraines. It is important to pay attention to a number of typical manifestations.

Symptoms occur no earlier than a few hours before the onset of menstruation and no later than the 3rd for menstruation. If these attacks occur a couple of days before menstruation or immediately after them, this rather speaks in favor of menstrual-associated migraine.
The head hurts almost always on one side, in the forehead, eyes, jaw. Less commonly, the head hurts in the back of the head.
The pain is aggravated by the slightest physical exertion, turning on lights, smells or sharp sounds.
Your head may pulsate in time with your own heart rate.

In addition, with a similar form of migraine, fluctuations in blood pressure, heart attacks, cold sweat suddenly appears, and nausea occurs. Against the background of severe pain, insomnia occurs, overall performance decreases, the woman simply cannot concentrate and do anything.

See a gynecologist or a neurologist?

With this problem, you should go to a neurologist. But if necessary, he will connect a female doctor to the treatment process. To exclude other causes of headache, it will be useful to take a general clinical blood test. This will help assess the general condition of the body.

In the case when the issue of prescribing combined oral contraceptives is being considered, the doctor may recommend a genetic test for mutations in the F2 and F5 genes to determine contraindications to prescribing COCs.

What can help with menstrual migraine

There are a number of tips that doctors offer to help alleviate the condition and reduce the severity of the condition.

Apply a cold cloth or ice pack to the head or neck. It is better to wrap the package in a cloth.
Drink enough water.
It is useful to do relaxation exercises. Yoga and meditation can help reduce stress and pain.
Sometimes acupuncture (acupuncture) can relieve the condition.
Your doctor may prescribe over-the-counter or prescription pain medications. If the cycle is regular, the appointment of painkillers or hormonal (estrogens) agents is possible a few days before menstruation, when there is no pain yet.

Estrogen preparations are taken strictly according to the doctor’s prescription, since in some people the start of taking COCs is accompanied by an improvement in their condition, while in others, on the contrary, headaches may increase.