About 60% of women with migraine headaches report a correlation between some of their headaches and their menstrual periods. Usually menstrual migraine occurs several days prior to the onset of menstrual flow up to the first day of flow; however some women report migraines only mid-cycle around the time of ovulation. The fact that migraine headaches can be tied to a woman's hormonal cycle is not surprising since three times as many women as men have migraine headaches.

Treatment for menstrually associated migraine attacks is typically the same as the treatment for common or classic migraine headaches.

A preventive agent can be used daily, a preventive agent can be used several days before the expected onset of the headache and continued for the expected duration of the headache (a mini prophylaxis), or the migraine can be treated with an analgesic medication or a "triptan" medication at the onset of the headache to shorten the attack. Narcotics and even oral steroids (prednisone) can be used during a severe or prolonged menstrually associated migraine headache to attempt to stop the headache.

There have been several studies looking at the use of hormonal therapy to reduce migraine headaches. These studies have shown that hormonal therapy can reduce the frequency of attacks and the intensity of attacks; however there is a threshold dosage of estrogen necessary to produce a beneficial effect and side effects do occur.

There is still controversy about the use of standard oral contraceptive agents in women with migraine headaches. The use of oral contraceptive agents is known to impart a small but statistically significant increased risk of stroke. In women who have migraine with aura (classic migraine), the use of oral contraceptive agents should be used with caution, especially if the woman develops worsening or prolonged aura or other focal neurological symptoms or signs.

In one study, about one third of women on oral contraceptive agents reported that their migraine pattern improved with that treatment alone. There is no established data to suggest that oral contraceptive agents cannot be used safely in women with cluster headaches or musculoskeletal (tension) headaches.

Fortunately most women with menstrually associated migraine headaches will have a reduction or resolution of their migraine attacks after menopause. At least that's something good to look forward to as you get older.