migraine catamenial migraine

Catamenial migraine: Headache during menstruation

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

La catamenial migraine is a headache that affects 20% to 60% of women with migraine. It appears around the period of the rules. Due to its recurrence and the difficulty of management, the catamenial migraine can be a real handicap for some women. It can therefore have psychological, family, social and economic consequences.

For all these reasons, it is important to provide detailed information on this pathology. More specifically, this article will define catamenial migraine, list its symptoms, talk about the means of treatment and especially its prevention.


La catamenial migraine occurs in women with a history of migraine. Migraine is defined as a headache (headache) without any organic cerebral lesion in question.

La catamenial migraine in particular is a migraine whose attacks occur according to the menstrual cycle. It is caused by the collapse of estradiol levels just before the onset of menstruation.

Catamenial migraine 1 catamenial migraine

There are two types of catamenial migraine According to the International Headache Society:

  • Pure catamenial migraine: it is rare and affects only 14% of women. It is only felt during menstruation. No other migraine attacks occur during the other phases of the menstrual cycle.
  • Migraine aggravated by menstruation: It includes migraine attacks during menstruation (between the second and third day of the cycle) as well as attacks outside of menstruation.

These crises of migraine outside the rules can be preceded by neurological symptoms called auras (visual, sensory or aphasic auras). Conversely, purely menstrual migraine attacks are not accompanied by auras. However, these are more severe, last longer and do not respond to usual pain treatments.

Pathophysiological mechanism

In the functioning of the female organism, two hormones play an essential role. These are estradiol and progesterone. Their rate drops at the end of the post-ovulatory phase. This fall therefore shortly precedes the onset of the crisis of catamenial migraine pure. The role of progesterone is not clearly established, but that of estradiol is. This implies sufficient prior estrogen impregnation.

Menstrual cycle catamenial migraine

Thus, a pre-menopausal woman has a higher risk of catamenial migraine because the rate of endogenous estradiol (produced by the body itself) is at its lowest. A biological predisposition has also been demonstrated.

Similarly, taking estrogen-progestogen contraception is often the cause of catamenial migraine in some women. Indeed, migraine attacks appear willingly during the 7 days of interruption of the pill and calm down as soon as they resume. This mode of administration, with interruption of contraceptives, is the cause of a drop in exogenous estrogen (not produced by the body) capable of triggering the crisis of catamenial migraine.

Symptoms of Catamenial Migraine

Symptoms of a catamenial migraine are those of a migraine without classic aura. This is a headache (headache) of moderate or severe intensity with the following characteristics:

  • The location of the pain is unilateral (on one side of the head only).
  • The pain is throbbing (the patient feels like he hears a heartbeat in the head).
  • The headache often requires rest.
  • The headache is aggravated by travel and usual daily activities.
Migraine 1 catamenial migraine

These headaches must have at least two of these characteristics. They can also be associated with either nausea, vomiting, photophobia (hypersensitivity to light) or phonophobia (hypersensitivity to noise). Often repetitive, the attacks are generally more prolonged and more intense than migraine attacks occurring outside of menstruation.

Treatment and prevention

Crisis treatment

Treatments during seizures catamenial migraine must be instituted at the start of the crisis, as soon as possible in order to be effective. They must be given at the right dosage and by the right route of administration (rectal route or injection, especially in the event of vomiting).

Traditional painkillers such as paracetamol are not generally effective. Furthermore, the triptans have proven their effectiveness in several studies. These include, among others, the sumatriptan, rizatriptan from the Association sumatriptan-naproxen. triptans are well tolerated by patients and have few side effects. In some patients they even reduce pain in the lower abdomen during menstruation (dysmenorrhea).

catamenial migraine medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as mefenamic acid is the treatment of choice for catamenial migraine because it decreases the flow of rules and also the pelvic pain.

Adjuvant treatments may possibly be associated with the treatment of the crisis. For example, anxiolytics and anti-emetics (against vomiting) can be added if other symptoms are present.

Finally, prevention of seizures remains the best treatment for catamenial migraine because of its recurring and rebellious nature.

Preventive treatment

Non-specific preventive treatment of catamenial migraine aims to reduce the frequency, severity and duration of seizures. It also improves the response to treatment. It will therefore be instituted in patients whose attacks persist despite the aforementioned curative treatments. It will also be implemented in patients who need high doses of drugs or several molecules before being relieved.

The success of preventive treatments depends on the possibilities of anticipating the onset of menstruation. Treatment begins a few days before the expected date of menstruation and continues during them. Thus, for example, naproxen 500 mg (NSAID) can be administered twice a day before and during menstruation. Triptans can also be used as a preventive treatment.

With regard to the specific preventive treatment, these are solutions aimed at avoiding the sudden drop in estrogen. The cutaneous route is the mode of administration of choice because it confers stability of the estrogen levels that it induces. Treatment with an estrogen-releasing patch or cream will be used 2 days before the expected date of the attack and continued for 7 days.

Catamenial migraine and contraception

 When migraine attacks with auras occur in women taking estrogen-progestogen contraceptives, it is necessary to recommend:

  • A permanent interruption of contraception thus reducing the risk of cerebrovascular accident (CVA).
  • Another option is to take the combined pill continuously. This causes amenorrhea (absence of periods) but decreases the risk of migraine.
  • We can change the usual pills by pills with a lower dose of estrogen allowing to have a shorter window of monthly interruption. This simple small change already helps prevent seizures. catamenial migraine in some women.

Some natural remedies

  • Naturopathy
  • Massage the temples at the beginning of the crisis with tiger balm.
Catamenial migraine massage
  • Drink ginger herbal tea: it has anti-inflammatory properties and helps to calm nausea.
Catamenial migraine ginger herbal tea
  •  Acupuncture.
  • Homeopathy.
  • Do relaxation exercises like meditation, yoga and sophrology.

Other precautions can also be taken to prevent seizures. catamenial migraine.

  • Identify all the factors likely to increase the intensity of seizures (diet, sleep and pace of life, stress, environmental conditions, etc.).
  • Avoid strong lights by preferring subdued lighting or by using a blue light filter on the screens.


 La catamenial migraine is a migraine induced by the drop in estradiol levels just before the onset of menses. There exists the catamenial migraine pure and migraine aggravated by menstruation.

Women on contraceptives are prone to catamenial migraine attacks because of the mode of administration comprising an interruption window and therefore leading to a drop in exogenous estrogens.

La catamenial migraine manifests in the same way as migraine without a classic aura. Nevertheless, catamenial migraine attacks are more intense, prolonged and are difficult to treat with usual methods.

The curative treatment of the attack will be effective if it is started early, at an appropriate dose and combined with adjuvant treatments. Apart from crises, prevention must be the priority solution, especially in women on estrogen-progestogen contraceptives.

Switching to lower dose estrogen pills, reducing or even eliminating the withdrawal period, may allow some women to avoid attacks of catamenial migraine.


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