Complex Relationship Between Menstrual Cycle and Monthly Migraine Days

Shot of a young woman suffering from stomach cramps on the sofa at home
Study authors investigated differences between women who experience migraines 2 days before menstruation or the first 3 days of menstruation.

Migraine days tended to peak among women between the 2 days prior to and the first 3 days of their menstrual cycle, according to findings from a longitudinal study published in Headache.

Data from a digital platform that tracked individual migraine-related factors were analyzed for this study. Actively menstruating adult women (N=203) self-reported perimenstrual and migraine statuses for between 91 to 1220 days. The International Classification of Headache Disorders, 3rd Edition (ICHD-3) defined menstrual-related migraine as having at least 1 migraine attack between 2 days prior to the start of menstruation and the first 3 days of bleeding in at least 2 of 3 menstrual cycles.

Study participants were a mean age of 35.6 years (standard deviation [SD], 8.7), the median headache days over the last 3 months was 24 days (interquartile range [IQR], 29), and 71.9% of participants were not using contraceptive medications.

Women were more likely to have a migraine day during the ICHD-3 defined perimenstrual window (odds ratio [OR], 1.34; 95% CI, 1.23-1.45; P <.0001). There was significant variance between women (P <.0001) and the degree to which menstruation affected migraine days differed significantly between women (P =.002).

Within women, there was a significant cycle-by-cycle effect (P <.0001) in which some cycles had a greater impact on monthly migraine days than others.

The associations between monthly cycle and migraine days were calculated for each woman separately. The ORs ranged from 0.79 to 2.18 and had a median of 1.22 (IQR, 1.22-1.48). Similarly, across all 2126 recorded cycles, the ORs for the association with migraine days ranged from 0.44 to 4.85 with a median of 1.31 (IQR, 1.04-1.65).

Among all women, 60.6% had at least 1 cycle with an OR for migraine days less than 1, 45.8% had at least 1 cycle with an OR for migraine days greater than 2, and 21.7% had a combination of those 2 types of cycles.

These findings may be limited by their convenience sampling and may not be generalizable among all women.

These data indicated there was substantial variation between and within women for the association between monthly menstrual cycles and migraine frequency.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


McGinley J S, Wirth R J, Pavlovic J M, et al. Between and within-woman differences in the association between menstruation and migraine days. Headache. Published online February 19, 2021. doi:10.1111/head.14058.