At a glance
- Menstrual migraine happens in a predictable window, from about two days before your period to its first three days.
- It's driven by the same drop in estrogen that triggers much of PMS, not a separate problem with your hormones.
- These attacks tend to be more severe, longer and harder to treat than migraine elsewhere in your cycle (Neurology, 2008).
- Triptans have grade B evidence for treating and preventing menstrual migraine, and newer CGRP drugs have shown real reductions in migraine days in trials.
- Tracking migraine days against your cycle for two months helps a doctor tell menstrual migraine apart from other headache patterns.
What is menstrual migraine?
Menstrual migraine is a migraine attack that clusters in the days around your period. Doctors call this the perimenstrual window, and it typically means:
- Starting about two days before your period begins and continuing through the first three days of your period (Headache, 2023)
- Feeling more severe, lasting longer and responding less well to pain relief than migraine at other points in your cycle (Neurology, 2008)
When attacks also happen at other times in the cycle, it's called menstrually related migraine, which affects an estimated 31 to 52 percent of women who already live with migraine (Journal of Headache and Pain, 2025).
The trigger is thought to be the sharp fall in estrogen right before your period starts, the same hormone shift behind much of PMS. For more on what's happening to your hormones in this window, see the luteal phase and menstrual cycle hormones, phase by phase.
How does it relate to PMS and PMDD?
Menstrual migraine, PMS and PMDD are separate diagnoses, but all three come from cyclic swings in estrogen and progesterone that act on the brain. Researchers increasingly study these as a related group, alongside:
- Menstrual migraine
- PMS
- PMDD
- Catamenial epilepsy (seizures that cluster around the cycle)
Each condition keeps its own diagnosis and treatment path, even though the hormonal triggers overlap (Frontiers in Neuroendocrinology, 2023).
That means you can have migraine, mood symptoms, or both in the same week before your period. One doesn't make the other less real.
Allopregnanolone, a hormone byproduct linked to anxiety and mood change before your period, is part of this same picture; see what allopregnanolone means. If your premenstrual pattern looks like more than physical symptoms, read about PMDD, explained.
What does research say about treatment?
Several drug classes have been tested specifically for menstrual migraine, with real differences in how well they work.
| Option | What it's for | Evidence |
|---|---|---|
| Triptans (sumatriptan, rizatriptan) | Acute treatment | Grade B evidence (Neurology, 2008) |
| Triptans (frovatriptan, naratriptan) | Short-term prevention | Grade B evidence (Neurology, 2008); zolmitriptan also performed well in a 2013 meta-analysis (Journal of Headache and Pain, 2013) |
| CGRP antibodies (erenumab, galcanezumab) | Monthly prevention | Fewer migraine days than placebo in large trials (Journal of Headache and Pain, 2020; Headache, 2024) |
| Gepants (ubrogepant, rimegepant) | Acute treatment or short-term prevention | Mixed results for acute use (Headache, 2023); a small five-patient case series found rimegepant prevented most perimenstrual attacks short-term, though lasting monthly benefit held in only one patient and some attacks simply shifted later in the cycle (Journal of Headache and Pain, 2025) |
| Lasmiditan | Acute treatment | More pain-free attacks at the higher dose tested in trials (Cephalalgia, 2022) |
A doctor weighs these against your migraine pattern, your health history and what you've already tried.
If your migraine shows up alongside anger or tears you can't explain, Niyora is a PMS and PMDD support app. Its Moon feature can help you write down what happened and work out what to say, even on a day a migraine makes thinking hard.
Related terms to know
A few related terms help explain what's going on:
- Luteal phase: the second half of your cycle, after ovulation, when estrogen and progesterone fall before your period starts. See the luteal phase.
- Corpus luteum: the structure left behind after ovulation that makes progesterone, then breaks down if you don't conceive, which is part of why hormones drop. See corpus luteum, what it means.
- Allopregnanolone: a hormone made from progesterone that affects mood and anxiety before your period. See allopregnanolone, what it means.
- PMDD: a diagnosed condition with mood and physical symptoms in the final week before your period. See PMDD, explained.
For a broader look at the hormone research behind all of these, see PMS and PMDD research, summarised.
From the research library
Research on migraine
146 studies in the library look at migraine in PMS and PMDD. They were published from 1962 to 2026, and each one has a short summary of what was tested and found.
146
studies, 1962 to 2026
How strong the studies are
- Strong study design
- 9
- Moderate study design
- 40
- Early or limited evidence
- 97
Systematic review, 2023
What hormonal treatments have been tested for PMDD, menstrual migraine, and catamenial epilepsy?
Hormonal treatments have been tested 56 times for premenstrual mood disorder, 21 times for menstrual migraine, and 8 times for catamenial epilepsy. Combined oral contraceptives were a frequent focus.
Strong study design
Cohort study, 2022
Can women accurately tell if they have period-related migraines, or do they need to track them?
No. Women couldn't accurately tell if they had period migraines. Most needed to keep a daily headache diary for several cycles for accurate diagnosis.
Strong study design
Guideline, 2021
How should migraine be managed in women, particularly menstrual migraine?
This guideline covers migraine treatment approaches, noting that menstrual migraine, pregnancy, contraception, and hormone therapy are specific considerations. The abstract does not provide specific treatment details for menstrual migraine.
Strong study design
Randomised trial, 2016
Does telcagepant prevent migraines during the menstrual period?
Telcagepant did not reduce overall monthly migraine days. However, it did reduce headaches on the days it was taken around the period. It was generally safe.
Strong study design
Randomised trial, 2014
Does the combination of sumatriptan and naproxen sodium reduce menstrual symptoms and migraine?
Yes. The combination was better than placebo for tiredness, irritability, bloating, abdominal pain, and back pain, as well as migraine. However, women with severe period pain responded less well to migraine treatment.
Strong study design
Randomised trial, 2005
Does sumatriptan work for migraines around the menstrual cycle?
Yes, sumatriptan 100 mg gave headache relief to 67% of women for migraines during their menstrual window compared to 33% on placebo. Sumatriptan was well tolerated.
Strong study design
Clinical trials
Questions people ask
What is menstrual migraine?+
Menstrual migraine is a migraine attack linked to the drop in estrogen right before your period, usually from two days before bleeding through the first three days. These attacks tend to be more severe, last longer and respond less well to pain relief than migraine at other times in your cycle (Neurology, 2008).
Is menstrual migraine the same as PMS or PMDD?+
Menstrual migraine, PMS and PMDD are separate diagnoses, but all three come from cyclic swings in estrogen and progesterone acting on the brain. You can have migraine, mood symptoms, or both in the same premenstrual week, and each is treated on its own terms (Frontiers in Neuroendocrinology, 2023).
How common is menstrually related migraine?+
Menstrually related migraine, where attacks also happen outside the perimenstrual window, affects an estimated 31 to 52 percent of women who already live with migraine (Journal of Headache and Pain, 2025). Pure menstrual migraine, where attacks only happen around your period, is less common.
What treatments work for menstrual migraine?+
Triptans have grade B evidence for treating and preventing menstrual migraine (Neurology, 2008). CGRP antibodies like erenumab and galcanezumab have reduced migraine days in large trials (Journal of Headache and Pain, 2020; Headache, 2024). A doctor can help you choose based on your pattern and health history.
When should I see a doctor about menstrual migraine?+
If migraine takes a week of every month, or doesn't ease with what you're currently using, bring a headache diary tracking your cycle to a doctor or neurologist. They can confirm the pattern and talk through treatment options with you.
Sources
- 1.A scoping review of hormonal clinical trials in menstrual cycle-related brain disorders: Studies in premenstrual mood disorder, menstrual migraine, and catamenial epilepsy, Frontiers in neuroendocrinology, 2023
- 2.Efficacy and safety of erenumab in women with a history of menstrual migraine, The journal of headache and pain, 2020
- 3.Acute treatment and prevention of menstrually related migraine headache: evidence-based review, Neurology, 2008
- 4.Triptans in prevention of menstrual migraine: a systematic review with meta-analysis, The journal of headache and pain, 2013
- 5.Efficacy of lasmiditan for the acute treatment of perimenstrual migraine, Cephalalgia : an international journal of headache, 2022
- 6.Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis, Headache, 2023
- 7.Short-term prevention of perimenstrual migraine with rimegepant, The journal of headache and pain, 2025
- 8.Effect of galcanezumab in women with episodic migraine meeting criteria for menstrually related migraine: A post hoc analysis of EVOLVE-1 and EVOLVE-2, Headache, 2024