Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Menstrual Migraine: Why It Happens, Treatments & HRT Options UK
A UK-focused, clinically reviewed guide to menstrual migraine — the oestrogen withdrawal mechanism, acute treatment, perimenstrual prophylaxis, hormonal prevention, the contraceptive pill safety issue (UKMEC), and HRT in perimenopause. All treatment information applies to UK-licensed medicines and NHS pathways.
When to get urgent help in the UK — call 999 or go to A&E straight away if you have:
- A sudden, severe headache that came on in seconds — often described as the worst headache of your life (thunderclap headache)
- Headache with fever, a stiff neck, a rash that does not fade under pressure, or confusion
- Headache with new weakness, numbness, slurred speech, or vision loss
- Headache after a head injury
For non-emergency advice in the UK, call NHS 111 or contact your GP. See your GP if you have a new headache over the age of 50, a headache that is getting worse over weeks, a headache triggered by coughing, straining or lying down, a first-ever migraine with aura, or headaches on more than 15 days a month.
▶ Menstrual migraine at a glance (UK)
Around 60% of women with migraine get attacks triggered by their period — specifically the fall in oestrogen in the days before a period. Menstrual attacks tend to be more severe and last longer than attacks at other times of the month. In the UK, NSAIDs (especially naproxen) are particularly effective, and triptans are the first-line prescription treatment for moderate to severe attacks. Short-course prevention around the period can stop attacks without needing daily medication. One important UK safety point: the combined pill is UKMEC category 4 in migraine with aura, meaning it must not be used. GPhC pharmacy #9011198.
60%
Of women with migraine have menstrual attacks
Day −2 to +3
Perimenstrual window when attacks cluster
Longer
Menstrual attacks are often more severe and last longer
UKMEC 4
Combined pill classification for migraine with aura (UK)
Why Menstrual Migraine Happens
Menstrual migraine is driven by the fall in oestrogen that happens in the late luteal phase, in the couple of days just before your period. That drop — not the rise, and not the hormone levels themselves — is what lowers the migraine threshold in women who are susceptible.
Prostaglandins released during menstruation add to the problem. That is why NSAIDs, which block prostaglandin production, are particularly effective for menstrual migraine compared with attacks at other times of the month. In the UK, naproxen is the NSAID most often used for this because it is longer-acting than ibuprofen and available on NHS prescription.
Pure menstrual migraine — attacks only around your period, never at any other time — affects roughly 10% of women with migraine. The more common pattern is menstrually-related migraine, where attacks happen around the period and at other times too, affecting about 50–60% of women with migraine.
Types of Menstrual Migraine
| Type | When attacks occur | How common |
|---|---|---|
| Pure menstrual migraine | Only on days −2 to +3 of your period. No attacks at other times of the month. | ~10% of women with migraine |
| Menstrually-related migraine | Around your period and at other times of the month as well. | ~50–60% of women with migraine |
Acute Treatment (UK)
The standard NHS approach to treating a migraine attack still applies. A few things are worth knowing for menstrual migraine specifically:
- NSAIDs (naproxen 500mg) — especially effective because of the prostaglandin mechanism. Take at the very first sign of an attack and continue as needed. Naproxen is available on NHS prescription in the UK and is also sold over the counter at lower doses. Naproxen for migraine guide →
- Triptans — effective and appropriate, and first-line NHS treatment for moderate to severe attacks. In the UK these are prescription-only and licensed from age 18 (sumatriptan, rizatriptan, zolmitriptan, almotriptan, frovatriptan, naratriptan). Triptans guide →
- Triptan plus naproxen together — works better than either on its own, particularly for menstrual attacks that drag on for days.
- Paracetamol — useful for milder attacks and safe in pregnancy. Do not exceed 4g (8 x 500mg tablets) in 24 hours.
Pregnancy and breastfeeding: If you are pregnant, trying to conceive, or breastfeeding, speak to your GP, midwife or obstetrician before taking any migraine medicine. Triptans are not licensed for use in pregnancy in the UK and should only be used on medical advice. Paracetamol is generally the preferred painkiller in pregnancy. If you are breastfeeding, sumatriptan is generally considered compatible but check with your GP or pharmacist first.
Driving: Triptans can cause drowsiness or dizziness in some people. If you feel drowsy after taking one, do not drive or operate machinery until you feel fully alert.
Medication Overuse Headache — A UK Guard Rail
One of the most common reasons migraines get worse over time is taking acute painkillers too often. This is called medication overuse headache (MOH), and it affects a significant number of people in the UK who treat migraine with over-the-counter medicines.
The NHS threshold is: using acute painkillers on 10 or more days a month (for triptans, opioids, or combination analgesics) or 15 or more days a month (for simple paracetamol, ibuprofen, or aspirin) for three months or more. If you are crossing that line, your headaches are likely being driven by the painkillers themselves — and the answer is usually to step down the acute medicine, not to add more.
If you think you might be in this pattern, speak to your GP before stopping anything abruptly. Stopping suddenly can make headaches temporarily worse, and it is safer to do this with medical support. NHS guidance and support are available via your GP surgery or NHS 111.
Perimenstrual Prophylaxis (UK)
If your periods are regular and predictable, you do not need to take medication every day to prevent menstrual migraine. A short course taken around the expected attack window — days −2 to +3 — can significantly reduce or prevent menstrual attacks altogether. These are all prescription-only medicines in the UK.
| Option | Regimen | Notes |
|---|---|---|
| Naproxen 500mg twice daily | Start 2–3 days before your expected period, continue for 5–7 days | Anti-prostaglandin mechanism; particularly well suited to menstrual migraine. Take with or after food. |
| Frovatriptan or naratriptan | Start 2 days before your expected period, continue for 6 days | Longer-acting triptans used preventively; via GP or specialist. UK licensed for this use in some patients. |
Do not start perimenstrual prophylaxis without medical advice — these medicines have side effects, and if you have migraine with aura, triptans and NSAIDs need careful assessment.
Hormonal Prevention (UK)
If you have menstrually-related migraine without aura, smoothing out the perimenstrual drop in oestrogen is another option. These are all UK-licensed treatments, and the consultation and prescribing happen through your GP, a sexual health clinic, or a UK-registered online prescriber.
- Transdermal oestrogen patches (100 microgram) applied 3 days before your expected period and continued for 7 days — delays the oestrogen withdrawal that triggers the attack
- Continuous combined oral contraceptive (no pill-free interval) — removes the withdrawal drop entirely; only suitable if you have migraine without aura
Contraception is free on the NHS in the UK — including the combined pill, progestogen-only pill, implant, injection, hormonal coil (IUS) and copper coil. You do not need to pay a prescription charge for contraception, and you do not need to be registered with a GP to get it. Sexual health clinics and most GP surgeries provide it. This is a UK-specific entitlement and worth knowing if cost is a factor in your choices.
If you have migraine with aura: oestrogen supplementation and combined hormonal contraceptives are contraindicated because of stroke risk — this is UKMEC category 4 for the combined pill (UK Medical Eligibility Criteria for Contraceptive Use). Progestogen-only methods (mini-pill, implant, hormonal coil) are safe, at UKMEC category 1. If you are not sure which type of migraine you have, your GP or pharmacist can help clarify. See migraine and the pill →
HRT and Migraine in Perimenopause (UK)
Perimenopause often makes migraine worse, because oestrogen swings up and down unpredictably. In the UK, transdermal HRT — patches or gel — is usually preferred over oral HRT for women with migraine, because it delivers oestrogen steadily through the skin and avoids the peaks and troughs that oral tablets can produce. Oral HRT can make attacks more frequent for some women.
If you have migraine with aura and are considering HRT, transdermal oestrogen combined with a progestogen has a more favourable safety profile than oral HRT. UKMEC guidance should still be followed, and the balance of risks is worth talking through with your GP. If you are already on HRT and notice your migraines getting worse, tell your prescriber — the type, dose, or route can often be changed.
Discuss migraine treatment online
Our GPhC-registered prescribers can assess menstrual migraine, acute treatment and perimenstrual prophylaxis options. All medicines dispensed are UK-licensed. GPhC pharmacy #9011198.
Start consultation →For HRT options in perimenopause and menopause: hormone replacement therapy at Access Doctor →
Frequently Asked Questions
Why do migraines get worse around my period?
Oestrogen drops sharply in the two days before your period. That sudden withdrawal lowers your migraine threshold if you are susceptible. Prostaglandins released during menstruation add to it, which is why NSAIDs like naproxen work particularly well for menstrual attacks.
What is the best treatment for menstrual migraine?
Naproxen 500mg and triptans (sumatriptan or rizatriptan) both work well for acute menstrual migraine, and combining them is better than either alone. If your cycles are predictable, short-course prevention starting two days before your period — naproxen twice daily or a longer-acting triptan — can stop attacks before they start. In the UK these are prescription-only medicines.
Can the pill help with menstrual migraine?
Only if you have migraine without aura. A combined oral contraceptive taken continuously, with no pill-free week, removes the monthly oestrogen drop and can prevent menstrual attacks. If you have migraine with aura, the combined pill is absolutely contraindicated under UKMEC (category 4) because of stroke risk. Contraception is free on the NHS in the UK.
Does menopause cure menstrual migraine?
Many women find their migraines settle after menopause as hormones stabilise. But perimenopause — the years leading up to it — often makes migraine worse because oestrogen swings unpredictably. In the UK, transdermal HRT is usually preferred over oral HRT for migraine because it delivers oestrogen steadily through the skin.
Is menstrual migraine covered under the NHS?
Yes. Acute treatments and preventive medicines for menstrual migraine are available on NHS prescription in the UK — and if you are exempt from prescription charges (for example, if you have a medical exemption certificate), you will not pay. Online private prescriptions are also available through Access Doctor following a clinical consultation.
References
- NICE. Headaches in over 12s: diagnosis and management. CG150. nice.org.uk/guidance/cg150
- MacGregor EA. Menstrual migraine. Neurol Clin. 2009.
- FSRH. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC). 2016 (amended 2019). fsrh.org
- NHS. Migraine. nhs.uk/conditions/migraine
- NHS. Medication overuse headaches. nhs.uk/conditions/headaches
- MHRA. Yellow Card Scheme — reporting suspected side effects. yellowcard.mhra.gov.uk
Medical disclaimer: This article is for general information only and is not a substitute for personalised medical advice. Prescription migraine treatments require a clinical consultation. Always speak to your GP, pharmacist, or NHS 111 if you are unsure. In a medical emergency in the UK, call 999.
Yellow Card: If you suspect you have had a side effect from any medicine mentioned in this article, you can report it to the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk. Reporting is voluntary and helps make UK medicines safer.