Hormonal Migraine: Why Migraines Hit Around Your Period and How to Treat Them

Written by Cherlie Joseph, MSN, FNP-BC · Medically reviewed by Naurah Gaspard, DNP, FNP-C, FNP-BC · Updated November 2026

Hormonal (menstrual) migraines are set off mainly by the drop in estrogen just before your period, so they cluster from about 2 days before to 3 days after bleeding starts. They can be treated with the same acute medicines as other migraines, plus short-term prevention around your period. If you have migraine with aura, estrogen-containing birth control is not recommended.

Why hormones trigger migraine

Estrogen levels drop sharply in the days before a period. In people with migraine, that drop appears to make the brain's pain pathways more easily set off. The same thing can happen during the hormone-free week of birth control pills, after giving birth, and during the uneven hormone swings of perimenopause.

Migraine is about three times more common in women than men after puberty, and hormones are a big part of the reason. Many women notice migraines often improve in the second and third trimesters of pregnancy, when estrogen is high and steady, and may ease after menopause.

Signs your migraines are hormonal

Doctors use two main patterns:

Type	Pattern
Pure menstrual migraine	Attacks happen only from 2 days before to 3 days after your period starts, in at least 2 out of 3 cycles
Menstrually related migraine	Attacks happen in that same window in at least 2 of 3 cycles, and also at other times of the month

Menstrual attacks are often longer, more severe, more likely to come with nausea and less responsive to treatment than other attacks. The only way to know your pattern is to track it. Keep a diary or app with your period start dates and migraine days for at least three cycles. Bring it to your visit; it makes treatment planning much easier. Our guide to migraine triggers explains what else to log.

Treating hormonal migraine

Acute treatment. Treat early. Options include NSAIDs such as naproxen, triptans such as sumatriptan, and gepants. Some people do best combining a triptan with an NSAID, under a provider's guidance.

Short-term (mini) prevention. If your periods are regular and your attacks are predictable, a provider may suggest taking a medicine for a few days around your period, such as an NSAID or a longer-acting triptan like frovatriptan or naratriptan. Studies of frovatriptan taken around menstruation showed fewer menstrual migraines. This works only if you can predict when your period will start.

Hormonal approaches. For people who also need birth control and do not have migraine with aura, using combined pills, the patch or the ring continuously (skipping the hormone-free days) can avoid the estrogen drop. Progestin-only methods are another option.

Ongoing prevention. If you also get migraines at other times or have them often, daily or monthly preventive medicine may make more sense. See migraine prevention.

Birth control and migraine with aura

This is an important safety point. Migraine with aura is linked to a higher risk of stroke, and estrogen adds to that risk. Under the CDC's U.S. Medical Eligibility Criteria, estrogen-containing birth control (combined pills, patch and ring) is not recommended for people who have migraine with aura, at any age.

Situation	Estrogen-containing methods	Progestin-only and non-hormonal methods
Migraine with aura	Not recommended (unacceptable risk)	Generally fine: progestin-only pill, implant, hormonal or copper IUD, shot
Migraine without aura	Often usable, depending on age, smoking, blood pressure and other risks	Fine

Aura means visual changes such as zigzag lines, flashing lights or blind spots, or tingling, usually lasting 5 to 60 minutes before or with the headache. If you develop aura for the first time while on estrogen-containing birth control, contact your provider promptly. More on choices in our birth control options guide.

Perimenopause, menopause and pregnancy

In perimenopause, cycles become irregular and estrogen swings up and down, so migraines may become more frequent or unpredictable for a few years. For many, they improve after periods stop. If you are considering hormone therapy for hot flashes, steady-dose transdermal (patch or gel) estrogen is often preferred for people with migraine, a decision to make with your provider.

If you are pregnant or trying to conceive, review your migraine medicines with a provider, since some are avoided in pregnancy.

Frequently asked questions

Why do I get migraines before my period?

Estrogen falls sharply in the days before your period. In people prone to migraine, that drop lowers the threshold for an attack. Other premenstrual changes, like poorer sleep, may add to it.

Can I take birth control if I get migraines?

Many people with migraine without aura can use combined birth control. If you have migraine with aura, the CDC advises against estrogen-containing methods because of stroke risk; progestin-only and non-hormonal methods are generally safe options.

Do hormonal migraines stop after menopause?

Often they improve once periods have stopped for a while, though migraines can worsen during perimenopause first. Some people continue to have migraines after menopause.

Sources

• NINDS: Migraine
• CDC: U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (summary chart)
• MacGregor EA. A review of frovatriptan for the treatment of menstrual migraine. Int J Womens Health (2014)

Keep reading

• Migraine vs headache
• Birth control options
• Perimenopause symptoms
• PMS and PMDD
• Browse all conditions and treatments A to Z

This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.