Headache and nausea during period

25 Oct Menstrual Migraine

Posted at 18:01h in Headache Fact Sheets by headache

Although only women suffer from “hormone headache,” both men’s and women’s headaches are prompted by hormones.

You would not feel pain without them, because it is the hormones that induce the pain response. Actually, the headache may be protecting you or warning you of something more damaging in the same way that touching a hot stove alerts you to the heat and protects you from burning yourself.

The word hormone is derived from a Greek word that means to “set in motion.” Hormones initiate and regulate many of your body’s functions. For example, metabolic hormones regulate the way your body turns food into energy. Growth hormones control childhood development and maintain certain tissue structure in adults. Regulating hormones determine your femininity, masculinity and sexuality.

Hormones are manufactured and secreted by your endocrine glands, which include the pituitary, thyroid, parathyroid, thymus, adrenals, pancreas, gonads and other glandular tissues located in your intestines, kidneys, lungs, heart, and blood vessels. The endocrine system works with your nervous system to keep your body in balance within a constantly changing environment.

As they interact, your endocrine and nervous systems are responsible for the thousands of automatic responses that regulate your bodily functions. They decide, for example, whether you will respond to a potential headache trigger with an actual sensation of pain.

Menstrual Migraine

Women suffer migraines three times more frequently than men do; and, menstrual migraines affect 60 percent of these women. They occur before, during or immediately after the period, or during ovulation.

While it is not the only hormonal culprit, serotonin is the primary hormonal trigger in everyone’s headache. Some researchers believe that migraine is an inherited disorder that somehow affects the way serotonin is metabolized in the body. But, for women, it is also the way the serotonin interacts with uniquely female hormones.

Menstrual migraines are primarily caused by estrogen, the female sex hormone that specifically regulates the menstrual cycle fluctuations throughout the cycle. When the levels of estrogen and progesterone change, women will be more vulnerable to headaches. Because oral contraceptives influence estrogen levels, women on birth control pills may experience more menstrual migraines.


The menstrual migraine’s symptoms are similar to migraine without aura. It begins as a one-sided, throbbing headache accompanied by nausea, vomiting, or sensitivity to bright lights and sounds. An aura may precede the menstrual migraine.

Menstrual Syndrome (PMS) Headaches

The PMS headache occurs before your period and is associated with a variety of symptoms that distinguish it from the typical menstrual headache. The symptoms include headache pain accompanied by fatigue, acne, joint pain, decreased urination, constipation and lack of coordination. You may also experience an increase in appetite and a craving for chocolate, salt, or alcohol.

Treatment – Menstrually Related Migraine

As you review these, remember that all medications have side effects, and you should discuss them with your doctor.

In general, MRM can be effectively managed with strategies similar to those used for non-MRM. Behavioral management is an important concept in menstrual as well as nonmenstrual migraine. Menstruation is one of many factors that puts women at risk for migraine. Hormonal changes are just one of many potential trigger factors.

Most sufferers of menstrually related migraine are treated with acute medications. When attacks are very frequent, severe, or disabling, preventive treatment may be required.

Acute Treatment

Medications that have been proven effective or that are commonly used for the acute treatment of MRM include nonsteroidal anti-inflammatory drugs (NSAIDs), dihydroergotamine (DHE), the triptans, and the combination of aspirin, acetaminophen, and caffeine (AAC). If severe attacks cannot be controlled with these medications, consider treatment with analgesics, corticosteroids, or dihydroergotamine.

Preventive Treatment

Women with very frequent and severe attacks are candidates for preventive therapy. For sufferers taking preventive medications who experience migraine attacks that break through the preventive therapy perimenstrually, the dose can be raised prior to menstruation. For sufferers not taking preventive medication, or for those with true menstrual migraine, short-term prophylaxis taken perimenstrually can be effective. Agents that have been used effectively perimenstrually for short-term prophylaxis include: naproxen sodium (or another NSAID) 550 mg twice a day; a triptan, such as frovatriptan 2.5 mg twice on the first day and then 2.5 mg daily/ naratriptan 1 mg twice a day/ sumatriptan 25 mg twice a day/ or, methylergonovine 0.2 mg twice a day; DHE either via nasal spray or injection 1 mg twice a day; and magnesium, equivalent to 500 mg twice a day.

The triptans, ergotamine, and DHE can be used at the time of menses without significant risk of developing dependence. As with the NSAIDs, these drugs will also be more effective as preventive medications if started 24 to 48 hours before the onset of the expected MRM.

Fluoxetine, especially if the headache is associated with other premenstrual dysphoric disorder (PMDD) symptoms, can be an effective headache preventive between ovulation and menses.

Hormonal Therapy

If standard preventive measures are unsuccessful, hormonal therapy may be indicated. This may involve the use of a supplemental estrogen taken perimenstrually either by mouth or in a transdermal patch. Estradiol (0.5 mg tablet twice a day, or 1 mg patch) is the preferred form of estrogen because it does not convert to the other active forms of estrogen.

For women using traditional estrogen/progesterone oral contraceptives for 21 days per month, the supplemental estrogen may be started on the last day of the pill pack. Another approach for women who take an estrogen/progesterone oral contraceptive is to take it daily – that is, without the monthly break – for 3 to 6 months. This has become accepted as a standard practice, and in Europe this approach has been used for up to a year with safety. The reduction in menstrual periods provides a method of preventive treatment.

Hormone headaches

Treatments for hormone headaches

Migraine treatments

Your doctor can also prescribe anti-migraine medicines for you to take around the time of your period.

These do not contain hormones, but they can help stop the headaches developing.

They include tablets called triptans and a type of painkiller called mefenamic acid.

Continuous contraceptive pills

Talk to your doctor if you think your contraceptive pills are making your migraines worse.

If you have headaches during the days you do not take the pills, you can avoid the sudden fall in oestrogen by taking several packs continuously without a break.

Find out more about the contraceptive pill

Hormone replacement therapy

The hormone changes that happen as women approach the menopause mean that all types of headache, including migraines, become more common.

Hormone replacement therapy (HRT) can be helpful to treat hot flushes and sweats.

But if you have migraines, it’s best to use patches or a gel, as these types of HRT keep hormone levels more stable than tablets and are less likely to trigger migraines.

Oestrogen therapy

If you have regular periods, a doctor can prescribe an oestrogen gel or patch, which you use before your period is due and for a few days during your period.

But these are not commonly prescribed for menstrual migraines.

I Throw Up During My Period. Is That Normal?

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When I get my period, sometimes it makes me throw up. Is this normal or bad for me, and what should I do?
– Annie*

Many girls throw up — or feel like they might throw up — just before or during their periods. Hormone changes are probably the cause, and these feelings usually go away in a day or two.

Treating menstrual cramps (with over-the-counter pain relief medicines, heating pads, etc.) can help some girls get rid of the nausea. You also might find that eating smaller, more frequent meals can help.

Sometimes, birth control pills can help ease some of the problems that girls get before or during a period.

Call your health care provider if:

  • you throw up a lot
  • you throw up for more than a couple of days
  • you can’t keep fluids down
  • the throwing up gets worse over time

Your provider can see if there’s another problem going on and can help make sure that you don’t get dehydrated.

*Names have been changed to protect user privacy.

Reviewed by: Larissa Hirsch, MD Date reviewed: May 2017

Premenstrual Syndrome (PMS)


There is no cure for PMS, but taking medicine may help. No single PMS treatment works for everyone, according to the National Institutes of Health (NIH). Consider taking over-the-counter pain relievers, such as ibuprofen, aspirin, or naproxen, to help ease cramps, headaches, backaches, and breast tenderness. Depending on your PMS symptoms and how severe they are, your doctor may prescribe medicine for you.

You may need to try more than one medicine to find the treatment that works best for you. Medicines that your doctor can prescribe include diuretics, antidepressants, and birth control pills.

What are diuretics?

Diuretics help your body get rid of extra sodium and fluid. They can ease bloating, weight gain, breast pain, and abdominal pain. Diuretics usually are taken just before you would normally experience these symptoms in your menstrual cycle.

Do antidepressants help?

Antidepressants can help with the severe irritability, depression, and anxiety that some women experience as part of PMS. These medicines are usually taken every day.

What about birth control pills?

Your doctor may talk to you about taking birth control pills (often just called “the pill”) to help ease some of your PMS symptoms. Birth control pills help by evening out your hormone levels throughout your cycle. Some women’s PMS symptoms get a lot better when they take birth control pills. However, the pill can also cause side effects of its own, and it doesn’t help all women.

What about medicines I can buy without a prescription?

You can buy medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or acetaminophen with caffeine, antihistamines, or diuretics. Some brand names include Midol, Pamprin, and Premsyn PMS.

These medicines can work quite well for mild or moderate PMS. Talk to your doctor before you try one of these drugs.

How to tell the difference between PMS and pregnancy symptoms

Symptoms common to both PMS and pregnancy include:

Changes in mood

Share on PinterestStomach cramps can be a symptom of both PMS and early pregnancy.

Feeling irritable, anxious, or sad, or having crying spells, are common in both early pregnancy and the days leading up to a period.

These symptoms of PMS typically disappear once menstruation begins. However, if mood changes persist and a person misses their period, this may suggest pregnancy.

Persistent feelings of sadness can indicate depression. See a doctor if low moods last for 2 weeks or more.

About 10 percent of pregnant women worldwide experience a mental health condition, depression being the most common.


Hormonal changes are a common cause of constipation in women. The fluctuations can slow down bowel movements.

Research suggests that constipation affects up to 38 percent of women during pregnancy, but it also affects many women just before their periods.

Pregnant women are most likely to have constipation in the first two trimesters, while women with PMS-related bowel problems typically experience relief after their periods begin.

Breast pain and tenderness

Breast changes are a common symptom of both PMS and early pregnancy. The changes can include:

  • pain
  • tenderness
  • swelling
  • heaviness
  • sensitivity
  • bumpy breast tissue

The severity of these symptoms varies among individuals.

However, in people with PMS, breast-related symptoms are usually most significant just before a menstrual period, and they typically get better during the period or just after it ends.

In early pregnancy, the breasts may feel particularly tender to the touch, and they often get heavier. The area around the nipple may sting or feel sore. Some women also develop more noticeable blue veins near the surface of the breasts.

Breast symptoms during pregnancy begin 1 or 2 weeks after conception and may persist until childbirth.


The hormone progesterone contributes to tiredness and fatigue before a period. Fatigue typically goes away once the period begins.

For women with heavy periods, excessive tiredness can last throughout the period. It may also be a sign of iron-deficiency anemia.

Fatigue is also a common symptom of early pregnancy. It often persists throughout the first trimester, and some women feel tired for the full 9 months. Difficulty sleeping and frequent nighttime urination can make pregnancy fatigue worse.

Bleeding or spotting

Light spotting or bleeding can occur in early pregnancy. This is called implantation bleeding, and it typically occurs 10–14 days after fertilization.

Many women do not experience implantation bleeding. Others may not notice it. It is much lighter than menstruation.

PMS does not typically cause spotting, although a period can be very light on the first day. Usually, menstrual bleeding lasts for 4 or 5 days, and it causes more significant blood loss than the spotting of implantation.


Cramping is common in both PMS and early pregnancy. Early pregnancy cramps are similar to menstrual cramps, but they can occur lower down in the stomach.

These cramps may persist for weeks or months during pregnancy, as the embryo implants and the uterus stretches.

Headaches and back pain

Hormonal changes can cause both headaches and back pain in early pregnancy and before the menstrual period.

Changes in appetite

Share on PinterestChanges in hormones may cause women to crave sweet foods before their period.

Increased appetite and food cravings are common symptoms of pregnancy, but they can also occur with PMS.

Many people with PMS experience increased appetite and cravings for sweet or fatty foods, or carbohydrate-rich meals. Changes in the hormones estrogen and progesterone likely influence cravings just before a period.

Research indicates that 50–90 percent of pregnant women in the United States have cravings.

Many crave specific foods and have aversions to others, finding their sight or smell deeply unpleasant. Food aversions are much less common in people with PMS.

Some pregnant women crave non-food items, such as ice or dirt. The medical term for this phenomenon is pica. Anyone with pica should speak to a doctor.

PMS, Cramps, and Irregular Periods

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A girl’s periods can cause some uncomfortable symptoms. Most of the time, there’s no reason for concern. But some problems need care from your doctor.

Here’s how to cope with most period problems.

What Is Premenstrual Syndrome (PMS)?

Premenstrual syndrome (PMS) is when a girl has mood and body changes before or during her period. It’s usually at its worst during the 4 days before a period. PMS usually goes away 2 to 3 days after the period begins.

What Are the Signs & Symptoms of PMS?

A girl with PMS might have:

  • sadness
  • mood swings
  • crankiness
  • anxiety
  • tiredness
  • food cravings
  • pimples
  • bloating
  • backaches
  • sore breasts
  • headaches
  • constipation
  • diarrhea

What Can Help if I Have PMS?

You can try these things if you have PMS symptoms:

  • To help with food cravings: Eat a balanced diet with lots of fresh fruit and vegetables.
  • To ease bloating: Lower salt in your diet.
  • To ease crankiness or anxiety: Avoid caffeine and get plenty of exercise.
  • To help with backache, headache, or sore breasts: Try a warm heating pad or acetaminophen (Tylenol or store brand), ibuprofen (Advil, Motrin, or store brand), or naproxen (Aleve or store brand).
  • To relax: Try yoga or meditation.
  • To prevent and treat pimples: Work with a dermatologist (skin doctor).

When Should I Call the Doctor?

If your PMS is severe, your doctor can help with treatments, including medicine. Call the doctor if you:

  • don’t feel better after trying home treatments
  • feel very sad or hopeless
  • ever think about hurting or killing yourself
  • can’t do your usual activities because of your PMS symptoms
  • have PMS symptoms that don’t go away after the first few days of your period

What Are Period Cramps?

Period cramps are pain in the lower belly during a girl’s period. Many girls have cramps during the first few days of their periods. Period cramps are caused by prostaglandin, a chemical in the body that makes the muscle in the uterus contract.

What Can Help if I Have Cramps?

If cramps bother you, try:

  • a warm heating pad on your belly
  • taking ibuprofen (Advil, Motrin, or store brand) or naproxen (Aleve or store brand); this works best if the medicine is started at the first sign of cramps

Call your doctor if:

  • severe cramps keep you home from school or doing your usual activities
  • the cramps do not get better with ibuprofen or naproxen

What Are Irregular Periods?

Irregular periods are when a girl or woman does not get a period about every 4–5 weeks. In the first 2 years after a girl starts getting her period, it is normal for the cycles to be irregular. But by about 2 years after periods start, they should be on a regular cycle.

What Can Help?

Track your periods so you know if they are regular. Record when your period comes, how long it lasts, and any problems you have during it. You can use a calendar or an app, or write it down in a notebook.

Call the doctor if you:

  • have had your period for 2 years and still don’t get it about every 4–5 weeks
  • get your period regularly, but then don’t get it for 3 months
  • get your period regularly, but then it becomes irregular
  • have periods that are very heavy (you go through more than one pad or tampon an hour)
  • have periods that last longer than about a week

Looking Ahead

Most girls settle into a regular period schedule and can manage any bothersome symptoms with home treatment. But talk to the doctor if you think there could be a problem with your periods.

Reviewed by: Krishna Wood White, MD, MPH Date reviewed: October 2018

Understanding Menstrual Migraines

Migraines afflict about 21 million women in the United States — three times more women than men. The disparity points strongly to hormones and the hormonal fluctuations experienced by women during the menstrual cycle. For this reason, migraines that are hormone-related are often referred to as menstrual migraines.

While it’s normal to experience some discomfort, like cramps or bloating, before and during a menstrual period far too many women also endure blinding headaches and excruciating pain. These menstrual migraines — which can occur before, during, or immediately after the period or during ovulation — commonly begin on one side of the head and are often accompanied by nausea, vomiting, and/or sensitivity to bright lights and sounds. Menstrual migraines differ from normal migraines in that they’re frequently more severe and last longer. In fact, according to research, menstrual migraines can last up to three days longer than a normal migraine.

Menstrual migraines tend to affect women who already suffer from regular migraines, and are primarily caused by estrogen, which regulates the menstrual cycle. When the levels of estrogen and progesterone change, women are more vulnerable to headaches. In fact, up to 60 percent of migraines in women overall are associated with menstruation.

These severe and debilitating headaches affect about 13 million women in America, including the tennis champion Serena Williams, who suffered from menstrual migraines for years without being diagnosed. The lack of diagnosis is a big problem when it comes to treating menstrual migraines: Because many women associate their period with feeling “under the weather,” they simply never find out that a menstrual migraine is a specific and treatable ailment.

Williams claims to have lost crucial matches while suffering from these brutal headaches, which were exacerbated by playing outdoors under bright lights. She also reported suffering from dizziness, nausea, and fatigue — all factors that can impair any woman’s everyday life.

While women suffering from menstrual migraines can experiment with alternative treatments like massage and acupuncture, most have found that their symptoms are best relieved by medicine taken just before the onset of menstruation and continued for the duration of the menstrual period, which is how Williams found solace. Taking hormones such as estrogen, or estrogen-related medications, also helps prevent migraines, and women with difficult-to-treat menstrual migraines may be helped by taking low-dose oral contraceptives to better regulate their hormones. Regardless of the treatment, it is paramount for women who experience more-painful-than-normal headaches during their periods to consult a doctor so they can resume leading normal, active lives.

Yes, Period Headaches Are a Real Thing—and Here’s How You Can Prevent Them

Periods can be annoying enough, even if we’re only talking about symptoms like cramping, bloating, and, of course, bleeding. But on top of that, many women find they also experience headaches at this time of the month, as well—adding yet another layer to an already less-than-pleasant few days.

If you’re one of those women, it may help to know that your recurring headaches aren’t just your imagination. Menstrual migraines and other types of headaches during (or before) your period are a real medical phenomenon, and experts say they’re actually quite common. Here’s what to know about this type of pain, and what you can do about it.

RELATED: 6 Things You Should Know About Having Sex During Your Period

Why do I get period headaches?

Your hormones fluctuate throughout your monthly menstrual cycle, says James Woods, MD, a professor of obstetrics and gynecology at the University of Rochester. Just before your period begins—assuming you didn’t become pregnant after ovulation—your estrogen levels drop sharply.

“People sometimes don’t realize that our hormones are linked to brain chemicals and to our mental state,” says Dr. Woods. “Any sudden change in hormones can mean changes in mood or anxiety levels, or it can mean experiencing more symptoms like headaches.”

Research suggests that up to 20% of women (and up to 60% of women who get regular migraines) experience a form of migraine tied to their period, known as menstrual migraines. These tend to occur in the two days leading up to a period and the three days after a period starts.

It’s hard to say whether all period-related headaches are migraines, says Dr. Woods, since the definition of migraines has changed and expanded over the years. “But what we can say is that the vast majority of these headaches are linked to this drop in hormones,” he says.

RELATED: 10 Things That Mess With Your Period

Menstrual migraine treatment and prevention

Since period-related headaches are fueled by hormonal changes, it can help to prevent large fluctuations, explains Dr. Woods. “A birth control pill that levels out those hormones throughout the month … can really help,” he says.

Some women will still get headaches during the placebo week of a 28-day pill regimen, Dr. Woods adds. If that happens, he says, doctors may recommend that patients skip the placebo week and start right in on a new pack of pills.

“You can do that for a couple years, and you effectively level the playing field across the whole month,” he says. “If there’s no change in hormones, you’re less likely to get those headaches.”

RELATED: Is It Really OK to Skip a Period Using Birth Control?

Women who are going through menopause often experience menstrual migraines as well. Wearing an estrogen patch or taking estrogen can help keep hormone levels stable during this transition and may help reduce headaches. Once a woman has stopped having periods altogether, those migraines are likely to stop as well.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription pain relievers (like triptans) can also help treat period headaches and may be good solutions for women who choose not to or cannot take hormonal birth control. (Some types of birth control may not be safe for women who get migraines with auras, for example.)

“Some people benefit from strong coffee, some people take Excedrin, and people increase their doses of their migraine medication,” says Dr. Woods. He recommends talking to your doctor about what type of medication regimen is best for you.

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Stress can also contribute to headaches, says Dr. Woods. Finding ways to relax during your period—and all month long—may help relieve symptoms. Alternative therapies, like acupuncture, yoga, or hypnosis, may benefit some people as well.

“There’s no one simplistic treatment that works for everyone,” Dr. Woods adds. “It’s often a trial of different approaches until we find something that fits.”

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