Migraines around menstruation: more risk of chronic headaches with medication

‘Increase sensitivity to migraine attacks’

‘Changes in sex hormones prior to menstruation increase the susceptibility to migraine attacks,’ says Professor of Neurology Gisela Terwindt. ‘That is why we see that in a large group of women menstruation is accompanied by migraine.’ In their study, the researchers compared perimenstrual and non-perimenstrual migraine attack characteristics.

Perimenstrual seizures more painful

For example, they found that perimenstrual attacks carry a higher risk of migraine recurrence, resulting in increased use of anti-migraine drugs, such as triptans. In addition, perimenstrual attacks were associated with a higher headache intensity and were perceived as more painful.

Preventive treatments

This has important implications for doctors who treat women with migraines, according to Terwindt. Doctors should be encouraged to prescribe preventive treatments in women with perimenstrual migraine attacks to reduce the duration and severity of attacks. This can prevent these women from having to take triptans for several consecutive days,’ explains Maassen van den Brink, Professor of Pharmacology.

Long-working triptans

“To reduce the chance of the headache returning, doctors may consider prescribing long-acting triptans for the acute treatment of migraine attacks or recommend additional intake of specific long-acting analgesics after the attack has responded to a triptan,” Terwindt added.

‘Extra research is very important’

The first authors of the study, Daphne van Casteren and Iris Verhagen, think their results emphasize that additional research into the provocative role of sex hormones in women with migraine is very important. In addition, they believe it underlines the need to develop women-specific preventive treatments.


A total of 500 women took part in the study. They kept track of their migraine attacks and menstrual bleeding with an E-diary. An algorithm analyzed this data and made it possible to diagnose migraine days. Currently, the WHAT! team (Women, Hormones, Attacks and Treatment) is conducting a sex hormone study and has started a clinical study on the effect of continuous use of birth control pills in women with migraines. More information about these studies can be found at www.whatstudy.nl.


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