What Causes Migraines in Women?

Reviewed on 5/20/2022
Woman with a migraine rubbing her temples
A rapid drop in estrogen levels just before a menstrual period causes menstrual migraines (“hormone headaches”) in females, which can start between two days before a menstrual period and the third day of flow.

A migraine headache is a neurological disorder that causes severe head pain along with sensitivity to light, sound, or smells.

A rapid drop in estrogen levels just before a menstrual period causes menstrual migraines in females.

  • About two-thirds of females who suffer migraine attacks have ones that start between two days before a menstrual period and the third day of flow. 
  • Also called “hormone headaches,” menstrual migraines tend to be more severe, last longer, and cause greater light sensitivity than attacks that happen during other times of the month.

In addition to hormones, migraine headache triggers include: 

  • Stress
  • Poor sleep
  • Caffeine
  • Dehydration
  • Alcohol
  • Weather changes or changes in barometric pressure
  • Certain foods and drinks, such as chocolate, processed foods with monosodium glutamate (MSG), foods with histamine, cheese and other dairy products, artificial sweeteners such as aspartame, cured meats, and foods with a strong smell
  • Bright lights (photophobia) 
  • Certain smells
  • Medication overuse 
    • Taking acute migraine prescription medication more than 10 days out of a month can in itself cause more migraine attacks
  • Anxiety
  • Depression
  • Fatigue
  • Anger
  • Hunger/skipping meals
  • Exposure to smoke
  • Certain prescription medications, such as nitroglycerin and estrogen
  • Concussions and traumatic brain injuries

What Are Symptoms of Migraines in Females?

Symptoms of migraine are usually described in five phases: 

  • Prodrome: warnings before a migraine
    • Subtle changes in sensations such as an unusual taste or smell
    • Fatigue
    • Mood changes
    • Muscle tension 
  • Aura: visual disturbances that precede the headache phase
    • Geometric patterns or flashing, colorful lights
    • Loss of vision on one side (hemianopsia)
    • Blind spots (scotomas)
  • Headache
    • May last 4-72 hours
    • Usually occurs on one side of the head, but may occur on both sides
    • Throbbing pain 
    • Sensitivity to light (photophobia) 
    • Sensitivity to sound (phonophobia)
    • Nausea
    • Vomiting
  • Headache termination
    • Pain usually goes away with sleep, even if the migraine is not treated
  • Postdrome: other signs can linger after the pain goes away
    • Fatigue
    • Inability to eat
    • Problems concentrating

What Is the Treatment for Migraines in Females?

Treatment for migraine headaches includes: 

  • Non-medical treatments
    • Avoiding triggers
    • Ice 
    • Heat
    • Getting adequate hydration
    • Deep breathing
    • Darkened room/covering your eyes
    • Rest
    • Massage
    • Biofeedback
  • Pain relievers
  • Hormones for menstrual migraines
    • Estrogen supplementation with a pill, vaginal gel, or patch during the menstrual week 
  • Magnesium supplementation 
  • Started on day 15 of the menstrual cycle, or 15 days from the start of a woman’s period and continued until the next period begins
  • Other medications
    • Triptans
    • Trigger point injections
    • OnabotulinumtoxinA (Botox)
  • Anti-nausea medications (antiemetics)
  • Selective serotonin 1F receptor agonist
  • Calcitonin-gene related peptide (CGRP) antagonists
  • Ergotamine preparations
  • Neuromodulation
  • Peripheral nerve blocks
Reviewed on 5/20/2022
Image Source: iStock Images