If your headaches seem to arrive on schedule, right before or during your period, hormones are likely playing a part. Menstrual migraine affects about 1 in 5 women who have migraine, and it is often under-recognised.
Emergency
Call triple zero (000) or go to your nearest emergency department if you have a headache and:
- it came on suddenly and is extremely painful, or feels like the worst headache of your life
- numbness or weakness in your face, arm or leg, or slurred speech
- confusion, drowsiness, or trouble walking, balancing or remembering
- loss of vision or double vision
- a seizure (fit)
- fever with a stiff neck, or a rash that does not fade when pressed
- it started after a head injury
- you are over 50 with a new headache and jaw pain when chewing, a tender scalp or temples, or changes to your vision (this can be giant cell arteritis, an inflammation of blood vessels that can cause permanent sight loss if not treated quickly)
Key points
- Hormonal headaches and menstrual migraine are linked to the drop in oestrogen in the days before and during your period.
- About 1 in 5 women with migraine have menstrual migraine.
- Menstrual migraine attacks tend to be more severe, last longer and respond less well to treatment than other migraine attacks.
- Keeping a headache and period diary for at least three cycles is the best way to confirm the pattern.
- Treatment includes pain relief, migraine-specific medicine, short courses of preventive medicine around your period, and hormonal options.
- A Doccy consultation can help with medical certificates, special consideration letters, contraception and repeat migraine preventive medicine.
What are hormonal headaches and menstrual migraine?
A hormonal headache is a headache influenced by changes in reproductive hormones, particularly oestrogen. The most common type is menstrual migraine, which follows a predictable pattern linked to your cycle.
Doctors use two terms. Pure menstrual migraine means attacks only happen in the window around your period (from 2 days before to 3 days after bleeding starts) and at no other time. This is rare. Menstrually related migraine is more common: attacks happen around your period and at other times of the month.
Hormonal headaches can also happen at other times of hormonal change, such as ovulation, the pill-free week of the contraceptive pill, pregnancy and perimenopause.
Not all headaches around your period are migraine. Some women get tension-type headaches before their period. Read more about the different types in our headache and migraine article.
Symptoms of menstrual migraine
Menstrual migraine usually causes moderate to severe, throbbing pain, often on one side of the head, lasting 4 to 72 hours if untreated. Compared with other migraine attacks, menstrual attacks tend to:
- last longer, often into the second or third day
- be more intense, with more nausea and vomiting
- respond less well to usual pain relief, and come back after treatment
Other common symptoms include sensitivity to light and sound, tiredness, difficulty concentrating and irritability.
Menstrual migraine usually happens without aura. If you get visual changes (flashing lights, blind spots, zigzag lines) or tingling before your headaches, tell your doctor. Migraine with aura affects which contraceptive options are safe for you.
When to see a doctor
If you have any of the signs in the emergency box at the top of this page, call triple zero (000) or go to your nearest emergency department.
Get an urgent GP appointment, or call healthdirect on 1800 022 222 for advice, if you have a headache and:
- you are over 50 and it is a new type of headache
- you are pregnant or have recently given birth
- it is worse when you cough, sneeze, bend down or lie down, or it wakes you with vomiting
- you have vision or eye problems
- you have a weakened immune system or have had cancer
- it is getting steadily worse over days or weeks
See a GP if:
- you get headaches regularly, or they are becoming more frequent
- you take pain relief for headaches on more than a few days a week
- your headache is not getting better with self-care
- you think your headaches are linked to your menstrual cycle and want to explore treatment options
If you are ever unsure, it is safer to seek medical advice.
Even if you have put up with these headaches for years, it is worth getting them assessed. Many women assume period headaches are "just something you deal with", but effective treatments exist.
Why does your cycle cause headaches?
Oestrogen withdrawal. Oestrogen levels fall sharply in the days before your period. This drop, rather than low oestrogen itself, is thought to trigger menstrual migraine, although a 2023 review found the evidence still has gaps.
Prostaglandins. These are the chemicals released during your period that cause cramping. They also increase inflammation and can make pain pathways more sensitive, which may explain why menstrual attacks are often more severe. Read more about period pain.
Risk factors include a personal or family history of migraine, migraine that started around your first period, headaches during other hormonal changes (starting or stopping the pill, pregnancy, perimenopause), and heavy or painful periods.
How menstrual migraine is diagnosed
There is no blood test or scan for menstrual migraine. The diagnosis is based on the pattern of your headaches.
Your doctor will ask you to keep a diary of your headache days and period days for at least three cycles. A headache or period tracking app can make this easier. Menstrual migraine is diagnosed when attacks happen in the window from 2 days before to 3 days after your period starts, in at least two out of three cycles.
Your doctor may also ask about how long your headaches last, medicines you have tried, whether you get aura, your contraception and other premenstrual symptoms. Scans and blood tests are not usually needed.
Treatment for menstrual migraine
During an attack:
- Anti-inflammatory medicines are often a good first option, because they also reduce the prostaglandins that cause period pain. They can be especially helpful if you also have heavy or painful periods.
- Triptans are prescription medicines made for migraine. For menstrual migraine, they work best taken at the first sign of an attack. They are not suitable for everyone.
- Anti-nausea medicine taken with pain relief can help if you feel sick.
Preventing attacks: if your attacks are predictable and severe, your doctor may suggest a short course of medicine taken for a few days around your expected period, rather than every day. Magnesium may help some women, but the evidence is limited.
Hormonal options: because the trigger is the drop in oestrogen, keeping hormone levels steadier can prevent attacks. Options your doctor may discuss include:
- taking the combined pill continuously, without the sugar-pill break (not suitable if you have migraine with aura, because of stroke risk)
- oestrogen patches or gel used around your period
- a hormonal IUD, contraceptive implant or injection, which may reduce or stop periods
- the progestogen-only pill, which does not carry the oestrogen-related stroke risk
The best choice depends on whether you have aura, your age, your heart and stroke risk, and whether you want contraception.
Self-care and living with menstrual migraine
- Track your cycle so you can plan around days that are usually difficult.
- Stay hydrated, especially in the week before your period.
- Keep a regular sleep routine, including on weekends. Too much or too little sleep can trigger attacks. See our sleep difficulties article.
- Keep caffeine consistent. Regular high intake followed by withdrawal on weekends can trigger attacks.
- Exercise regularly, such as walking, swimming or cycling a few times a week.
- Manage stress. The let-down after a stressful week is a common trigger. Read more about stress.
Outlook
Menstrual migraine is not dangerous, but it can affect your quality of life. Using pain relief too often (more than about 10 to 15 days a month, depending on the medicine) can cause medication overuse headache, which makes headaches worse.
The pattern often changes over time. Many women find migraine improves during pregnancy, especially later in pregnancy, and after menopause. Perimenopause can be harder, as hormone levels fluctuate. With the right mix of treatment and self-care, most women can greatly reduce the impact of menstrual migraine.
How Doccy doctors can help
A Doccy consultation can help if you have a known pattern of headaches or migraine around your period, and none of the warning signs on this page. A Doccy consultation can:
- provide a medical certificate if a headache or migraine means you need time off work or study
- provide a special consideration letter if recurring migraine has affected a university assessment or deadline
- continue a prescription for the migraine preventive medicine you already take, if it is appropriate
- prescribe contraception, including options that may help hormonal headaches, if it is appropriate
- refer you to a neurologist if you have frequent, severe migraine that has not improved with preventive treatment
A Doccy consultation is not suitable for a new headache that has not been assessed, or if you have any of the signs in the emergency box or a headache that needs an urgent GP appointment. A doctor cannot examine your nervous system or eyes remotely, so these headaches need to be assessed in person.
Resources and support
healthdirect: health information and a 24-hour nurse advice line on 1800 022 222.
Migraine and Headache Australia: information on all headache types, including hormonal and menstrual migraine, and headache diaries.
Migraine Australia: consumer resources on migraine, treatment and hormonal triggers.
Jean Hailes for Women's Health: information on hormones, periods and migraine.
These services and websites can provide extra information, but they do not replace advice from your own doctor.
- healthdirect. Migraine. 2025. https://www.healthdirect.gov.au/migraine
- Migraine and Headache Australia. Hormonal headaches and menstrual migraine. https://headacheaustralia.org.au/hormonal-headaches-menstrual-migraine/
- Jean Hailes for Women's Health. What is hormonal migraine? https://www.jeanhailes.org.au/health-a-z/migraine/what-is-hormonal-migraine
- Vetvik KG, MacGregor EA. Menstrual migraine: a distinct disorder needing greater recognition. Lancet Neurol. 2021;20(4):304-315. https://pubmed.ncbi.nlm.nih.gov/33600767/
- Raffaelli B, Do TP, Chaudhry BA, et al. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. J Headache Pain. 2023;24:131. https://pubmed.ncbi.nlm.nih.gov/37730536/
- Migraine Australia. Menstrual or hormonal migraine. https://www.migraine.org.au