Management of Menstrual Migraine at Keilor Road Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on May 27, 2025
What is a menstrual migraine
Causes and triggers for menstrual migraine
Risk factors for menstrual migraine
How to manage menstrual migraine: Best treatment options in Melbourne
When to seek professional help for menstrual migraine
Why choose Keilor Road Physiotherapy for menstrual migraine treatment
Menstrual migraines are a common and debilitating condition affecting many women, particularly around the time of menstruation. Unlike typical headaches, menstrual migraines are associated with hormonal fluctuations, specifically the drop in estrogen levels just before or during your period. These migraines can be severe, impacting daily activities and overall quality of life. Fortunately, effective treatments are available, and at Keilor Road Physiotherapy, we offer personalised care to help manage and reduce the severity of menstrual migraines.
What are menstrual migraines?
Menstrual migraines are a type of migraine that occurs in conjunction with your menstrual cycle, typically occurring from two days before to three days after menstruation begins. This type of migraine is notoriously severe, persists longer than other migraines, and generally shows a poor response to traditional pharmacological treatments. The ongoing medical debate questions whether menstrual migraine is a distinct subtype or simply a hormonal trigger of regular migraine episodes.
Symptoms of Menstrual Migraines:
Severe, throbbing headache often on one side of the head
Nausea and vomiting
Sensitivity to light (photophobia) and sound (phonophobia)
Increased sensitivity to smells (osmophobia)
Fatigue and difficulty concentrating
Unlike other types of headaches, menstrual migraines are tied to hormonal fluctuations. They may also be triggered or worsened by factors such as stress, lack of sleep, or certain foods.
The Aura Phase in Menstrual Migraines
While many women experience menstrual migraines without aura, some may also experience an aura phase before the headache begins. An aura is a group of sensory disturbances that often include visual changes such as flashing lights, blind spots, or zigzag patterns, typically occurring 5 to 60 minutes before the headache.
Menstrual migraine is characterized by migraine attacks that closely align with the menstrual cycle,. However, at Keilor Road Physiotherapy, we focus on the tangible impacts and the best approaches to treatment, rather than semantic classifications.
Diagnosing menstrual migraine
Recognised under the appendix of the International Classification of Headache Disorders (ICHD-3) as a condition needing more research for full validation, menstrual migraine is categorised into:
Pure Menstrual Migraine: Attacks that exclusively coincide with menstruation.
Menstrually-Related Migraine: Attacks that occur during menstruation and at other times during the cycle, complicating the diagnosis and management.
Causes and triggers of menstrual migraine
The core issue in menstrual migraine is the heightened sensitivity of the Trigemino-Cervical Complex (TCC)—a crucial area within the brainstem where trigeminal nerves (head and face) interact with upper cervical nerves. This area functions as a neural highway for headache signals. Menstrual migraines are often triggered by the dual impact of falling estrogen levels, which diminish the brain's pain control mechanisms, and the release of inflammatory prostaglandins that further sensitise the brainstem (Chaudhary, 2021).
Common causes:
Hormonal Changes: Estrogen levels drop during the menstrual cycle, increasing the likelihood of a migraine.
Stress: Physical or emotional stress can trigger a migraine attack.
Sleep Disturbances: Poor sleep patterns or disrupted sleep can exacerbate migraine symptoms.
Dietary Triggers: Foods such as chocolate, caffeine, or alcohol can also trigger migraines.
Bright Lights and Strong Smells: Sensory triggers like bright lights, strong odors, or loud noises can worsen symptoms.
Best menstrual migraine treatment Melbourne.
Risk factors for menstrual migraine
Menstrual migraines, like other types of migraines, are influenced by a combination of genetic, environmental, and hormonal factors. Understanding these risk factors can help individuals identify whether they are more prone to menstrual migraines and manage their condition more effectively.
1. Hormonal Changes
Hormonal fluctuations play a significant role in the development of menstrual migraines. The most common triggers for these migraines are changes in estrogen levels, which drop just before menstruation and during the menstrual cycle (Chaudhary, 2021).
Estrogen: Estrogen helps regulate many bodily functions, including mood and pain perception. A decrease in estrogen levels can make the brain more sensitive to pain, triggering a migraine. This is why many women experience menstrual migraines in the days leading up to or during their periods, when estrogen levels naturally drop.
Other hormonal changes: Hormonal fluctuations during pregnancy, perimenopause, and menopause can also affect the frequency and severity of menstrual migraines. For instance, some women may experience a reduction in the severity of menstrual migraines during pregnancy due to increased estrogen levels, while others may experience migraines for the first time during perimenopause as estrogen levels begin to fluctuate and decline.
2. Family History and Genetics
Genetic factors play a substantial role in the likelihood of developing menstrual migraines. Studies show that individuals with a family history of migraines are more likely to experience them themselves (Kalarani et al., 2022).
Genetic predisposition: It is believed that mutations in certain genes, including those responsible for regulating the calcium channels (such as the CACNA1A gene), increase an individual’s sensitivity to triggers like hormonal changes. A strong family history of migraines, particularly those associated with menstruation, may indicate an inherited risk of menstrual migraines.
Migraine susceptibility: Research indicates that women who experience migraines are more likely to have a family member who suffers from the same condition. A family history of migraines increases the likelihood of developing menstrual migraines due to shared genetic traits.
3. Age
Menstrual migraines commonly begin in women in their late teens to early twenties and are most prevalent during the reproductive years (Pavlovic, 2020). These migraines tend to peak in severity between the ages of 18 and 35. However, as women approach perimenopause and menopause, the frequency of menstrual migraines often decreases due to hormonal stabilization. Some women may experience a reduction in the frequency of menstrual migraines after menopause, while others may experience new types of headaches or worsening symptoms.
4. Stress
Stress is one of the most common triggers for menstrual migraines. Stress can activate the body's fight-or-flight response, releasing hormones like cortisol and adrenaline, which can increase migraine susceptibility (Moy, 2022).
Emotional stress: Daily stressors, such as work pressures, family responsibilities, or personal challenges, can trigger migraines. The combination of physical and emotional stress can amplify the migraine response in susceptible individuals.
Physical stress: Overexertion, lack of sleep, and physical exhaustion can also contribute to the onset of menstrual migraines. Women who have busy or physically demanding lifestyles may be at a higher risk of developing migraines.
5. Sleep Disturbances
Sleep disturbances are closely linked to an increased risk of migraines, including menstrual migraines. Poor or inadequate sleep can contribute to a heightened sensitivity to pain, making it easier for a migraine to develop (Moy, 2022).
Sleep deprivation: Lack of sleep or poor-quality sleep can cause a cascade of biological responses that increase the likelihood of migraines. This is particularly true for individuals who are already prone to menstrual migraines.
Irregular sleep patterns: A disrupted sleep schedule, such as frequent changes in bedtime or waking times, can also contribute to migraine frequency, especially in women with menstrual cycle-related migraines.
6. Dietary Factors
Certain dietary triggers are known to contribute to the development of menstrual migraines. Foods and beverages can either provoke or exacerbate migraine symptoms by influencing blood sugar levels, hydration, and neurotransmitter production (Moy, 2022).
Caffeine: Caffeine can both trigger and alleviate migraines. While it can provide short-term relief by constricting blood vessels, regular caffeine consumption can lead to withdrawal headaches, especially when combined with hormonal fluctuations during menstruation.
Chocolate and processed foods: Chocolate contains caffeine and a chemical called theobromine, which can trigger migraines in some individuals. Processed foods that are high in sodium or contain artificial additives may also increase migraine frequency.
Alcohol: Alcohol, especially red wine, is a well-known trigger for migraines due to its histamine content and its ability to dilate blood vessels. Women who drink alcohol during menstruation may be more prone to developing migraines.
7. Other Environmental Triggers
In addition to hormonal and lifestyle factors, various environmental triggers can exacerbate menstrual migraines (Moy, 2022):
Bright lights: Exposure to bright, flickering, or artificial lights can trigger migraines in some individuals. Light sensitivity (photophobia) is a common symptom of menstrual migraines.
Strong smells: Strong odors, such as perfumes, cleaning products, or food aromas, may act as triggers, especially when hormonal fluctuations are occurring during menstruation.
Weather changes: Shifts in weather, temperature, or barometric pressure can trigger migraines. Some women experience a higher frequency of menstrual migraines during seasonal changes or extreme weather conditions.
How to manage menstrual migraine: Best treatment options in Melbourne
Managing menstrual migraines requires a multifaceted approach, combining medical treatments, physiotherapy, lifestyle adjustments, and stress management. Since menstrual migraines are triggered primarily by hormonal fluctuations, particularly drops in estrogen around menstruation, treatment options aim to prevent and alleviate symptoms while addressing the root causes. Here are the most effective strategies for managing menstrual migraines:
1. Preventive Medications
Preventive medications are designed to reduce the frequency, severity, and duration of menstrual migraines by stabilizing the hormonal fluctuations and addressing the underlying triggers.
Hormonal Treatments
Hormonal therapies, particularly oral contraceptives or hormonal replacement therapy (HRT), are often used to prevent menstrual migraines. These treatments help regulate estrogen levels and prevent the drop that typically triggers migraines.
Birth Control Pills: Combined oral contraceptives can help stabilize estrogen levels and prevent the hormonal fluctuations that trigger menstrual migraines (D'Souza et al., 2023).
Hormonal Replacement Therapy (HRT): For women going through perimenopause or menopause, HRT can help balance hormone levels and prevent migraines (Harper-Harrison, 2025).
Beta-Blockers and Antidepressants
Beta-blockers like propranolol and antidepressants such as amitriptyline are often prescribed to help reduce the frequency of migraines. These medications regulate serotonin levels and help prevent migraines from occurring (Lampl et al., 2023).
2. Acute Treatment for Menstrual Migraines
Once a migraine attack has begun, acute treatments focus on relieving the symptoms and providing relief from the pain and discomfort associated with the migraine.
Triptans
Triptans, such as sumatriptan, are considered the gold standard in the treatment of moderate to severe migraines. These medications work by stimulating serotonin receptors in the brain, reducing pain and inflammation associated with migraines.
NSAIDs: Non-steroidal anti-inflammatory drugs (e.g., ibuprofen) can help alleviate the pain and reduce inflammation, especially in the early stages of the migraine.
Anti-Nausea Medications
Many individuals with menstrual migraines experience nausea or vomiting. Anti-nausea medications, such as metoclopramide, can help alleviate these symptoms and provide relief during an attack (Goadsby et al., 2017).
3. Physiotherapy for Menstrual Migraines
Physiotherapy plays a crucial role in both preventing and managing menstrual migraines, especially when neck dysfunction or poor posture is contributing to migraine attacks.
Manual Therapy
Manual therapy techniques such as spinal mobilisation and soft tissue massage can help alleviate neck and upper back tension, which is often a contributing factor in migraine onset. These techniques help relax muscles, improve blood flow, and reduce pain (Macgregor, 2009)
Neck Mobilisations: Mobilising the cervical spine can improve joint mobility and reduce stiffness in the neck, which can often trigger migraines.
Postural Education and Exercise
Poor posture can lead to tension in the upper back and neck, which may increase the likelihood of a migraine attack. Postural correction exercises and strengthening routines that focus on improving posture and reducing muscle strain can significantly help reduce the frequency and severity of migraines.
Postural Training: Physiotherapists will guide patients through exercises designed to improve posture, strengthen neck muscles, and alleviate pressure on the cervical spine.
Targeted Exercise Programs: Regular exercise, particularly those that focus on improving strength and flexibility in the neck and upper back, can prevent migraines by reducing tension and improving circulation.
4. Lifestyle Adjustments
Managing menstrual migraines also involves making adjustments to daily habits and routines to reduce the likelihood of attacks (Agbetou et al., 2022).
Stress Management
Stress is one of the most common triggers for menstrual migraines. Developing effective coping strategies for managing stress can help reduce migraine frequency. Techniques such as deep breathing, yoga, and progressive muscle relaxation are all beneficial for reducing stress levels.
Sleep Hygiene
Regular, high-quality sleep is essential for managing menstrual migraines. Ensuring 7 to 9 hours of sleep each night and maintaining a consistent sleep schedule can significantly reduce the frequency of migraine attacks.
Dietary Modifications
Certain foods and drinks can trigger menstrual migraines, including caffeine, alcohol, and processed foods. Identifying and avoiding food triggers is an essential part of migraine management. Additionally, maintaining regular meals can help stabilize blood sugar levels, reducing the risk of migraines.
Hydration: Staying hydrated is essential, as dehydration can be a significant migraine trigger.
5. Complementary Therapies
In addition to conventional treatments, complementary therapies can provide further relief for menstrual migraines.
Acupuncture
Acupuncture has been shown to reduce migraine frequency and intensity in some patients by improving circulation, reducing inflammation, and relieving muscle tension (Yang et al., 2022).
Cognitive Behavioral Therapy (CBT)
CBT is a type of talk therapy that helps individuals change negative thought patterns and develop coping strategies. It is particularly effective for managing the stress and anxiety that often accompany migraines (Bae et al., 2021)
When to seek professional help for menstrual migraine
While many menstrual migraines can be managed with lifestyle changes and medication, there are times when it’s important to seek professional medical attention. Here are key signs that you should seek help:
1. Frequent or Severe Migraines
If you experience more than two to three migraines per month, or if your migraines are becoming significantly worse, it may indicate that your treatment plan needs adjustment. Frequent migraines may require preventive treatment.
2. Changing or Worsening Symptoms
If the nature, intensity, or duration of your migraines changes or worsens, it’s important to consult a healthcare provider. New or more severe symptoms may indicate a need for a different treatment approach.
3. Neurological Symptoms
If you experience weakness, numbness, difficulty speaking, or vision problems during a migraine, seek immediate medical attention. These symptoms can indicate a TIA (stroke-like event) or hemiplegic migraine, which need urgent evaluation.
4. Medication Overuse
Using medication frequently (more than two to three times a week) or relying on over-the-counter pain relief may lead to medication rebound headaches. A healthcare provider can adjust your treatment plan.
5. Ineffectiveness of Current Treatment
If your current treatment options are no longer effective, or your migraines continue despite treatment, it’s important to reassess your approach with a healthcare provider.
6. Sudden, Severe Headache
If you experience the “worst headache of your life” or a thunderclap headache, seek immediate medical attention. These can indicate serious conditions such as stroke or aneurysm.
7. Impact on Quality of Life
If your migraines significantly affect your ability to carry out daily tasks, such as work or social activities, it’s time to consult a healthcare provider for a comprehensive treatment plan.
8. History of Stroke or Cardiovascular Disease
If you have a personal or family history of stroke or cardiovascular issues, it’s crucial to seek professional help, as menstrual migraines slightly increase the risk of stroke.
Menstrual migraine management Melbourne.
Why choose Keilor Road Physiotherapy for menstrual migraine management?
he Watson Headache® approach: A specific treatment for migraine with aura
Our treatment approach is centered around the Watson Headache® Approach, which targets the underlying irritation in the trigemino-cervical complex. This method has been validated through clinical research to reduce the 'noise' that triggers migraine aura, thereby normalizing brainstem function and reducing the occurrence of migraines.
Comprehensive diagnosis and understanding symptoms
Menstrual migraine involves specific diagnostic criteria, including:
Occurrence within 2 days before menstruation or within 3 days of menstruation onset in at least two out of three cycles.
Symptoms that typically develop gradually and are followed by a headache that lasts from 4 - 72hours.
Exclusion of other headache, migraine and more sinister diagnosis.
At Keilor Road Physiotherapy, we conduct a thorough assessment to accurately diagnose menstrual migraine and differentiate it from other headache disorders. This ensures that our treatment plans are tailored effectively to each individual’s needs.
Epidemiological insights and treatment implications
Recognising the individuality of each case, our treatment plans are meticulously customised. We explore all angles—dietary habits, sleep quality, stress management, and physical activity levels—to construct a comprehensive management plan. Our objective goes beyond symptomatic relief, aiming to empower patients towards long-term management and a significantly improved quality of life.
References
Agbetou, M., & Adoukonou, T. (2022). Lifestyle Modifications for Migraine Management. Frontiers in Neurology, 13, 719467. https://doi.org/10.3389/fneur.2022.719467
Bae, J. Y., Sung, H. K., Kwon, N. Y., Go, H. Y., Kim, T. J., Shin, S. M., & Lee, S. (2021). Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 58(1), 44. https://doi.org/10.3390/medicina58010044
Chaudhary A. (2021). Migraine Associated with Menstruation: An Overlooked Trigger. JNMA; Journal of the Nepal Medical Association, 59(238), 611–613. https://doi.org/10.31729/jnma.6332
D'Souza, A. C., Wageh, M., Williams, J. S., Colenso-Semple, L. M., McCarthy, D. G., McKay, A. K. A., Elliott-Sale, K. J., Burke, L. M., Parise, G., MacDonald, M. J., Tarnopolsky, M. A., & Phillips, S. M. (2023). Menstrual Cycle Hormones and Oral Contraceptives: A Multimethod Systems Physiology-Based Review of Their Impact on Key Aspects of Female Physiology. Journal of Applied Physiology (Bethesda, Md. : 1985), 135(6), 1284–1299. https://doi.org/10.1152/japplphysiol.00346.2023
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews, 97(2), 553–622. https://doi.org/10.1152/physrev.00034.2015
Harper-Harrison G, Carlson K, Shanahan MM. Hormone Replacement Therapy. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493191/
Kalarani, I. B., Mohammed, V., & Veerabathiran, R. (2022). Genetics of Menstrual Migraine and Their Association with Female Hormonal Factors. Annals of Indian Academy of Neurology, 25(3), 383–388. https://doi.org/10.4103/aian.aian_1116_21
Lampl, C., MaassenVanDenBrink, A., Deligianni, C.I. et al. The Comparative Effectiveness of Migraine Preventive Drugs: A Systematic Review and Network Meta-Analysis. J Headache Pain, 24, 56 (2023). https://doi.org/10.1186/s10194-023-01594-1
Macgregor E. A. (2009). Menstrual Migraine: Therapeutic Approaches. Therapeutic Advances in Neurological Disorders, 2(5), 327–336. https://doi.org/10.1177/1756285609335537
Moy G, Gupta V. Menstrual-Related Headache. [Updated 2022 Oct 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557451/
Pavlovic J. M. (2020). The Impact of Midlife on Migraine in Women: Summary of Current Views. Women's Midlife Health, 6, 11. https://doi.org/10.1186/s40695-020-00059-8
Yang, M., Du, T., Long, H., Sun, M., Liang, F., & Lao, L. (2022). Acupuncture for Menstrual Migraine: A Systematic Review. BMJ Supportive & Palliative Care, 12(e6), e882–e892. https://doi.org/10.1136/bmjspcare-2019-002024
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.