What is the Origin of Menstrual Migraine?

The etiology is fundamentally hormonal, tracing back to the discovery of the strong correlation between fluctuating gonadal steroids and central nervous system excitability. The phenomenon is rooted in the physiological mechanism of estrogen withdrawal, which sensitizes the brain to other migraine triggers in susceptible individuals. This distinct hormonal link differentiates them from non-menstrual migraines, often making them more challenging to treat.

What is the Mechanism of Menstrual Migraine?

The core mechanism involves the withdrawal of estrogen, particularly estradiol, which modulates the activity of neurotransmitters like serotonin and calcitonin gene-related peptide (CGRP) within the trigeminovascular system. The sudden drop in estrogen destabilizes the neuronal threshold, increasing the brain's excitability and vulnerability to a migraine attack. Prostaglandins, hormone-like substances released during menstruation, may also contribute to the neurovascular inflammation that characterizes the pain phase.

Menstrual Migraine

Meaning

Menstrual Migraine is a specific, often severe, form of migraine headache whose occurrence is closely linked to the perimenstrual phase of the female reproductive cycle. These migraines are primarily triggered by the rapid decline in circulating estrogen levels that naturally occurs in the late luteal phase, typically two days before the onset of menses and continuing through the third day of bleeding. They are clinically recognized as either “pure” menstrual migraines, occurring only at this time, or menstrually-related migraines.