Migraine in Women: Symptoms and Causes

• Researched and written by: Nishtha Chaudhary

• Edited by: Vaibhavi Kodnani

• Medical inputs and review by: Dr Poonguzhali Liston, MBBS, MS OBG, FMAS, DRM, FRM, CIMP, EDHM

TL;DR

• Migraine is a neurological condition that affects women more often than men, with women roughly three times more likely to experience it.[1,2]

• The common symptoms of migraine may include throbbing head pain, nausea, and sensitivity to light and sound.[3]

• One of the most common triggers of migraine in women includes hormonal fluctuations, particularly changes in estrogen linked to the menstrual cycle, pregnancy, postpartum, and perimenopause. Other triggers could include stress, poor sleep, dehydration, and certain foods.[4,5,6,7,8,9]

• Migraine can be managed with a combination of acute treatments (taken during an attack), preventive medications, and lifestyle strategies. A doctor can provide personalised plans.[1]

Migraine in Women: A Quick Introduction

Migraine is more than just a bad headache. It is a neurological condition that causes recurring, moderate to severe throbbing pain, usually on one side of the head. There are two main types of migraine:[1,3]

• Migraine without aura: Typically involves throbbing head pain along with symptoms such as nausea and sensitivity to light and sound.

• Migraine with aura: Also involves head pain, but is preceded or accompanied by aura, which are temporary neurological symptoms such as flashes of light, blind spots, tingling, or difficulty speaking. Aura usually lasts between 5 and 60 minutes.

Note: While migraine with and without aura are the main categories, there are many specialised types of migraines. Hemiplegic migraines are characterised by motor weakness and vestibular migraines are particularly associated with balance issues.[1]

Migraine is very common, especially in women, who are about three times more likely to experience it than men.[2] In South Asia, nearly 123 million women aged 15–49 live with migraine, with India bearing the largest burden of any country in the region.[10] Globally, nearly 60% of women with migraine experience menstrual migraines[11], while roughly 25% have migraines during perimenopause.[10]

Migraine usually lasts from 4 to 72 hours, and attacks can be unpredictable. This can make it difficult to manage work, relationships, and everyday responsibilities.[12] If migraines occur on fewer than 15 days a month, it is known as episodic migraine. In some cases, migraine can become chronic, with headaches occurring on 15 or more days a month for at least three months.[1]

Why are migraine headaches common in women?

While the exact cause of migraine is not fully understood, research suggests that changes in estrogen levels can trigger attacks. When estrogen levels fluctuate, they can affect blood vessels in the brain and increase sensitivity to pain.[13] Women are more likely to develop it after menarche (the first period) and may have more frequent attacks during their reproductive years.[4]

Symptoms of Migraine in Women

Migraine symptoms can vary from person to person and even from one attack to another. While a severe headache is the most recognisable sign, a migraine occurs in phases, each one bringing a different set of symptoms affecting different parts of the body. Not everyone will experience every phase, but common migraine symptoms include:[1,3] 

Prodrome (the early warning phase)

The prodrome phase can begin hours to two days before the headache itself and usually eases once the headache starts.

• Mood changes, irritability, or low mood

• Unusual fatigue or low energy

• Frequent yawning

• Neck stiffness

• Specific food cravings

• Increased urination

Aura (in some people)

Aura lasts 5 to 60 minutes; may occur just before or alongside the headache. 

• Visual disturbances such as flashing lights, zigzag lines, or blind spots

• Tingling or numbness in the face or hands, feeling like pins and needles

• Difficulty speaking or finding words

Headache (the main attack)

The headache can last 4 to 72 hours. 

• Moderate-to-severe, throbbing or pulsating pain, often on one side of the head, though it can affect both sides

• Pain that worsens with movement or physical activity

• Sensitivity to light, sound, or smells

• Nausea, which may lead to vomiting

• Dizziness or a sense of imbalance

Postdrome (the recovery phase)

The postdrome phase can last several hours up to two days after the headache eases. 

• Feeling drained, exhausted, or "hungover"

• Fatigue or difficulty concentrating

• Neck stiffness

• Mood changes 

What Triggers a Migraine in Women?

Migraine triggers can be different for everyone. What may trigger migraine in one person might not affect someone else at all. Some of the most common triggers of migraines in women include:[8,9]

• Hormonal changes: Drops in estrogen levels, especially before the period, or fluctuations during the postpartum period and perimenopause.

• Stress: Both ongoing stress and the “let-down” phase when stress levels suddenly drop.

• Sleep disruptions: Sleeping too little, too much, or changes in your sleep routine.

• Skipping meals: Going long hours without eating or having irregular meal timings, both affecting blood sugar levels.

• Dehydration: Not drinking enough fluids during the day.

• Caffeine: Both excess caffeine and sudden withdrawal.

• Sensory stimuli: Bright lights, loud sounds, strong smells, or prolonged screen exposure.

• Weather changes: Shifts in temperature, humidity, or air pressure.

• Certain foods and drinks: Aged cheese, processed foods, and alcohol.

• Physical overexertion: Sudden or intense physical activity, particularly if not already used to it.

Remember: In many cases, a single factor or a combination of factors can act as common triggers for migraine. Keeping a migraine diary can help you spot patterns and identify which triggers are most relevant to you. However, remember not to self-diagnose your migraine triggers and take action on your own. It’s best to take the information to a doctor and let them guide you through the trigger management process. 

Migraine Across Different Life Stages

Migraines can change across different stages of a woman's life. This is largely because hormonal shifts influence how often attacks occur, when they happen, and how intense they feel. As these hormone patterns change over time, you may notice clear differences in migraine frequency, timing, and severity.[6,7]

Note: Medications and supplements for migraine discussed in this section are for informational purposes only. If you have migraines, it is always best to speak with a doctor about the right option, dosage, and duration of treatment.

Menarche

Menarche, or the start of menstruation, is often when girls first develop migraines. This is the stage when the body begins regular hormonal cycles, with fluctuations in estrogen and progesterone that can trigger migraine.[4]

At this stage, migraines may start to follow a pattern, particularly in the days just before or during a period, when estrogen levels drop.[4] These early attacks may not always be recognised as migraine and can be dismissed as "period headaches." Girls may notice changes in timing and frequency as their cycle becomes more regular. For many, patterns become easier to recognise and manage over time.[14]

How migraines during puberty impact life: Migraines during menarche can affect everyday life in important ways, such as missing school, difficulty concentrating, or feeling unprepared to manage symptoms alongside periods.

Migraine treatment during puberty: At this stage, treatment often focuses on non-medication approaches such as regular sleep, consistent meals, staying hydrated, and physical activity. If medication is needed, paracetamol or ibuprofen are commonly used as first-line options.[15]

Reproductive years

During the reproductive years, hormonal patterns become more regular and have a stronger influence on migraine. Many women experience menstrual migraine attacks that are closely linked to their menstrual cycle. This can present in two ways:[16]

• Pure menstrual migraine: Attacks occur only in the days around menstruation, with no attacks at other points in the cycle.

• Menstrually-related migraine: Attacks occur around menstruation but also at other points in the cycle, meaning headaches are not limited to period days. 

How migraines during reproductive years impact life: These migraines are often more intense, longer-lasting, and harder to manage than attacks at other times of the month, largely due to the sharp drop in estrogen levels just before your period.[16] For women balancing work, relationships, and daily responsibilities, recurring attacks can affect productivity and overall quality of life.

Migraine treatment during reproductive years: During this stage, treatment includes identifying personal triggers and making lifestyle adjustments such as maintaining consistent sleep, regular meals, hydration, and light exercise. During an attack, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and migraine-specific medicines such as triptans (medicines that work specifically on migraine pathways in the brain), may be used.[16,17]

Pregnancy

Migraine during pregnancy often changes in noticeable ways. For many women, symptoms may improve in the second and third trimesters. This is likely due to more stable estrogen levels, which reduce the hormonal fluctuations that can trigger attacks. However, some women, particularly those with migraine with aura, may continue to experience attacks, and the first trimester can still be challenging. This may happen due to hormonal changes after embryo implantation, including a rapid rise in beta hCG (human chorionic gonadotropin) and changes in estrogen levels.[4,18]

How migraines during pregnancy impact life: The impact of migraine during pregnancy extends beyond discomfort. Some research suggests it may be linked to certain complications, such as pre-eclampsia (a pregnancy complication involving high blood pressure) or low birth weight. While this does not affect everyone, regular check-ups can help ensure both your and your baby's well-being.[18]

Migraine treatment during pregnancy: During pregnancy, treatment options are more limited, so care usually begins with non-medication approaches such as regular sleep, staying hydrated, eating on time, and managing stress. For migraine attacks, paracetamol is commonly used for pain relief. If this does not help, certain migraine-specific medicines such as sumatriptan may be considered in some cases.[18,19]

Postpartum and breastfeeding

Migraine often returns after delivery, sometimes within the first few days. The drop in estrogen levels after birth, along with sleep deprivation, physical exhaustion, and irregular meals, can trigger attacks.[18]

You may also notice changes in migraine patterns during this time, especially if symptoms improved during pregnancy. If you are breastfeeding, migraine may return later in some cases. This is because breastfeeding can delay the return of menstruation and keep hormone levels relatively stable.[20] However, this can vary from person to person.

How migraines during postpartum and breastfeeding impact life: Migraine during this stage can make it harder to care for a newborn and manage daily tasks, especially alongside disrupted sleep and ongoing fatigue.

Migraine treatment during postpartum and breastfeeding: During breastfeeding, it is important to choose medications carefully, as some can pass into breast milk. Paracetamol and ibuprofen are commonly used for relief, and in some cases, migraine-specific medicines such as sumatriptan may also be considered. If attacks are frequent or difficult to manage, preventive options such as magnesium supplements may be considered under medical guidance.[21]

Perimenopause

Perimenopause, the transition leading up to your final menstrual period, can be one of the most challenging stages for migraine. During this time, hormone levels fluctuate unpredictably, which can make attacks harder to predict and manage.[22]

You may notice changes in migraine patterns, including more frequent or intense attacks. Once you reach menopause and hormone levels stabilise, you may experience a reduction in migraine frequency. However, this is not the case for everyone, and some women may continue to have attacks.[22,23]

How migraines during perimenopause impact life: Migraine during this stage can affect daily functioning, especially alongside disrupted sleep, hot flushes, and mood changes. Increased frequency or intensity of attacks can make it harder to keep up with work and everyday responsibilities. 

Migraine treatment during perimenopause: Treatment may shift towards managing hormonal changes. In some cases, hormone replacement therapy (HRT) may be considered under medical guidance.[22]

Migraines and Hormonal Treatment

Hormones play a key role in migraine, which means hormonal treatments such as oral contraceptive pills (OCPs), hormonal IUDs, and hormone replacement therapy (HRT) can influence migraine patterns. The relationship between migraine and these treatments can vary from person to person, so individual response matters.[24]

Different hormonal treatments may influence migraine differently. Understanding these differences can help in making informed choices:

When to See a Doctor?

Many people live with migraine for years without ever receiving a proper diagnosis or an effective treatment plan. If migraine is affecting your quality of life, even occasionally, it may be time to seek help.

Consider seeing a doctor if:

• You notice a worsening of migraine over time, with attacks becoming more frequent or intense.

• Your headaches significantly affect work, study, daily activities, mental health, or relationships, even if they do not happen often.

• You notice new or unusual migraine patterns.

• Your headaches consistently occur around your period.

• You find yourself taking painkillers frequently to manage attacks, and they often don’t help. 

• You experience aura, such as visual changes, numbness, or difficulty speaking.

• You develop new-onset migraines during pregnancy or the postpartum period.

• You have a sudden increase in migraine frequency or intensity during the perimenopause stage. 

Seek urgent medical care if:

• You experience a sudden, extremely severe headache that reaches peak intensity within seconds, sometimes called a thunderclap headache.

• You develop weakness, difficulty speaking, facial drooping, confusion, loss of consciousness, persistent numbness, or vision loss.

• You have a headache with fever, neck stiffness, repeated vomiting, severe dizziness, or seizures.

• Your headache occurs after a head injury.

• You wake up from sleep regularly because of headaches.

• Your headaches worsen with coughing, bending, or straining.

Berry's Tips: What Should You Do When You Get Migraine Attacks?

When a migraine attack begins, acting early can make a meaningful difference. These doctor-backed steps can help you manage migraine and reduce the severity of the attacks: 

• Take acute migraine medicine: Take a painkiller, triptans, or any other acute migraine medicine prescribed by your doctor within 30 to 60 minutes of the aura or headache phase symptoms. These symptoms may include visual disturbances, numbness, throbbing head pain, nausea or vomiting, and sensitivity to light or sound.

• Shift to a low stimulation environment: Go to a dark, quiet, and cool room. Also, keep away from screens, loud sounds and strong smells. Limiting sensory input can help prevent migraine symptoms from intensifying.

• Take rest: Lie down for at least 30 minutes in the side sleeping position with the neck and head slightly elevated and supported with a pillow. If you are able to sleep, even briefly, it may help reduce or stop the migraine.

• Use cold therapy for 20–30 minutes: Wear a cooling cap, use a cold patch, or apply a cold compress or ice pack (wrapped in a cloth) to your forehead and the back of your neck. Cold therapy works by producing a numbing effect, narrowing the blood vessels around the brain, and reducing inflammation. 

Tip: Learn more about a cooling cap and how it helps with immediate relief during an attack. 

• Practice breathing exercises for 5–10 minutes: Practice alternate nostril breathing (nadi shodhana pranayama) to help calm the nervous system, release tension, and ease the mind. You can also practice humming bee breath (brahmari pranayama) or ocean breath (ujjayi pranayama).

• Perform a gentle side neck stretch: Stretching can relieve pain and muscle tension around the head and neck. It can also shift the nervous system out of “fight or flight” into “relax and heal” mode. To perform the stretch, sit upright, tilt head to right shoulder, hold for 30 seconds, repeat on left, 3–4 times each side.

• Sip water or electrolyte drinks: Slowly sip an electrolyte drink such as coconut water or a glass of water mixed with hydration salts. Continue drinking 2 to 2.5 litres of water to stay hydrated throughout the day. Avoid consuming large amounts of fluids at once. 

• Eat a light snack: Eat bland, easy-to-digest foods that have little to no smell and require low cooking effort. This can help stabilise blood sugar and prevent the migraine attack from worsening. You can have toast, crackers, banana, rice, curd, oats, khichdi, soup, or smoothies. Avoid heavy, oily, or strongly spiced foods, especially if you feel nauseous.

• Have ginger: Ginger is known to help with nausea and vomiting. You can make fresh ginger tea (without milk) but if that causes acidity, you can suck on ginger candy. 

• Consume small amounts of caffeine (if not a trigger): Caffeine can temporarily narrow blood vessels around the brain, reducing pressure in the head. Drinking a cup of coffee or tea can help, but only if caffeine is not a migraine trigger for you. 

Tip: 100–200 mg of caffeine per day is well tolerated if caffeine is not a migraine trigger for you. That equals 1 cup of brewed coffee or 2 cups of tea.

The Bottom Line

Migraine is a common neurological condition that affects women more often than men, largely due to hormonal fluctuations across menstruation, postpartum, and perimenopause. 

With the right combination of lifestyle adjustments, trigger awareness, and medical treatment where needed, migraine can be managed well. If it is affecting your quality of life, speaking with a doctor can help you find a plan that works for you.

FAQs on Migraines and Women's Health

What causes migraines in females?

The exact cause of migraine is not fully understood. However, research suggests that when estrogen levels fluctuate, they can affect blood vessels and increase sensitivity to pain in the brain, leading to migraine.[13]

What triggers a migraine?

Common triggers include stress, poor sleep, hormonal changes, dehydration, strong smells, and certain foods, though triggers can vary from person to person.[8,9] 

What nutritional deficiencies are linked to migraines?

Low levels of magnesium, riboflavin (vitamin B2), and vitamin D have been linked to migraine pain in some people.[25]

What is the fastest way to stop a migraine?

Acting early with prescription medication, along with using cold therapy and resting in a dark, quiet space, may help manage a migraine attack before it becomes more severe.

Do females get more migraines?

Yes, women are about three times more likely to experience migraine than men, largely due to hormonal changes throughout different life stages after puberty.[2]

References

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25. Nattagh-Eshtivani E, Sani MA, Dahri M, Ghalichi F, Ghavami A, Arjang P, Tarighat-Esfanjani A. The role of nutrients in the pathogenesis and treatment of migraine headaches. Biomedicine & Pharmacotherapy. 2018 Jun 1;102:317-25.