The Difference Between a Menstrual Migraine and Chronic Migraine

Migraine is a common—and often debilitating—condition that affects millions of women, but not all migraine attacks happen at the same time or with the same frequency. For instance, a menstrual migraine attack may be triggered in a different way than a chronic migraine attack. 

Understanding the distinctions between these two types is key to finding the right treatment and managing symptoms effectively. The more you notice when and how your migraine attacks present, the easier it will be to figure out what kind of treatment would work best for your unique type of migraine. 

Below, we break down the differences between menstrual migraine and chronic migraine, helping you better understand your migraine and how to manage it.

What is a menstrual migraine?

Menstrual migraine is directly tied to your hormone fluctuation and is timed to either your period or when you ovulate. 

According to the American Migraine Foundation, two out of three women who live with migraine live with menstrual migraine. 

These migraine attacks are typically triggered by hormonal fluctuations, particularly the drop in estrogen levels that happens just before menstruation. 

Menstrual migraine symptoms include expected migraine symptoms like a headache, nausea, vomiting, or sensitivity to light, but they are also uniquely timed. These migraine attacks typically happen a few days before your period and resolve once your period has tapered off. The biggest tell for a menstrual migraine is that it happens monthly at around the same time. 

What is a chronic migraine?

Chronic migraine is defined by its frequency. If you experience migraine on 15 or more days per month for at least three months, you may be diagnosed with chronic migraine. Unlike menstrual migraines, chronic migraines are not uniquely tied to your menstrual cycle and can occur at any time throughout the month, however, hormonal fluctuations can still play a role in increasing their severity.

Chronic migraine is a more persistent and long-term form of migraine. It can develop from episodic migraine, which may occur less frequently, into a chronic pattern over time.

Some chronic migraine attack symptoms include 15 or more headache days per month for at least three months, moderate to severe pain, and, for some people, auras. On some days, the pain may be less intense, but the headache can still linger and interfere with daily activities.

What are the key differences between menstrual migraine and chronic migraine?

While both types of migraine involve similar symptoms, like throbbing headache pain, nausea, and sensitivity to light, there are key differences between menstrual migraine and chronic migraine. 

Most notably, menstrual migraine attacks tend to resolve with the end of a period, while chronic migraine attacks can linger for several days and vary in intensity. Since a menstrual migraine is often more predictable, it is more realistic for someone to have a self-care plan at the ready for whenever their period is expected. Whereas, chronic migraine attacks may make it harder for someone to know when to expect a migraine or what to do when one occurs. 

Despite the differences, both menstrual and chronic migraines are influenced by hormonal fluctuations, especially estrogen. During your menstrual cycle, a drop in estrogen can trigger a migraine, particularly for those who already have a genetic predisposition to migraine. However, while menstrual migraine occurs with more predictable timing, chronic migraine is not necessarily linked to the menstrual cycle. It may still be influenced by hormonal changes (like pregnancy, menopause, or oral contraceptives), but the pattern is less predictable.

For women with chronic migraine, the hormonal component can exacerbate their condition, but chronic migraine often has additional triggers such as stress, sleep disturbances, or environmental factors (like bright lights or strong smells).

Managing menstrual migraine and chronic migraine

Managing both types of migraines involves a combination of lifestyle adjustments, medications, and identifying triggers. 

Some women find relief through hormonal treatments, such as birth control pills or hormone therapy, which can help stabilize estrogen levels and prevent migraine attacks from occurring during their periods. Over-the-counter medications like ibuprofen or acetaminophen are often a first line of defense to help alleviate pain, however, more personalized treatments (like triptans or anti-nausea medications) may be the path forward for some who live with migraine. 

In addition to medication, lifestyle adjustments can also help in migraine management. For instance, for those who live with menstrual migraine, keeping track of your cycle, staying hydrated, managing stress, and getting enough sleep can help reduce the frequency of menstrual migraine.

While both menstrual migraine and chronic migraine involve similar symptoms, understanding the differences between them is essential in determining the right treatment approach. If you’re experiencing migraine tied to your menstrual cycle, it’s crucial to discuss hormonal options with your care team, including an OB/GYN or headache specialist. 

How to manage your migraine at work 

Migraine can strike at the most inconvenient times, and for many women, those times are often right in the middle of their ever-growing to-do list. Managing migraine then becomes not only a physical health issue to tend to but also a balancing act of taking care of your loved ones, your work, and your responsibilities at the same time. While it can be hard (and sometimes impossible) to stay productive when you're dealing with a migraine attack, it may be helpful to prep some strategies and tools ahead of time for those harder days. 

Track your triggers

Keeping a migraine diary can be a game-changer. In your diary, note when your migraine attacks occur, what you ate, how much sleep you got, and any other relevant details (such as stress levels or hormonal changes). By identifying patterns, you can eventually better anticipate potential triggers and avoid them. There are also migraine-tracking apps that make it easy to track your symptoms and share that information with your healthcare provider.

Stay hydrated and eat regularly 

Dehydration and skipping meals can be significant migraine triggers. Drinking water consistently throughout the day and eating balanced meals may help prevent a migraine before it starts. Keeping healthy snacks (like nuts, fruit, or granola bars) at your desk can make it easier to stay on top of your nutrition, even when you're busy.

Commit to stress management practices

Chronic stress is a common migraine trigger. Finding ways to manage stress before it builds up can go a long way in preventing migraine. Consider using stress-reducing techniques like deep breathing, meditation, or mindfulness to keep your anxiety levels in check, especially before you start your workday.

Create a migraine-friendly workspace

Your physical environment plays a big role in how well you’re able to manage a migraine at work. Adjusting your workspace to be migraine-friendly can help reduce triggers and make it easier to stay as focused as possible during a mild migraine attack. As an added support, you can also consider swapping out lightbulbs or implementing ergonomic furniture into your workspace. 

Build a migraine action kit

Having a migraine action kit at work (and in your bag for when you're on the go) is an easy way to prepare for a potential attack. This "kit" can be customized based on your specific symptoms and needs but should generally include tools that can help you manage your migraine quickly, like medications or snacks.

Ask for a break

If you feel a migraine coming on while you're at work, taking a break early can make a world of difference. The longer you push through the symptoms, the harder it may be to manage them. Use your break times strategically to rest and reduce the intensity of the migraine. If you don’t have the option to sit in your office in the dark for a few minutes, think about other ways that taking a break may be more feasible, like taking a walk or sitting in your car or bathroom for a few minutes. 

Cut yourself slack and put a pause on work 

While it’s admirable to try and work through a migraine, sometimes the best option is to leave work and rest at home. If your migraine symptoms are severe and medications or self-care strategies aren’t helping, don’t hesitate to take time off. Your health should always be your priority.

If you frequently experience migraine, it may help to have a conversation with your manager about how you can best manage your condition at work and explain that there may be moments when you need to leave.

Migraine management doesn’t have to mean feeling powerless in the face of pain. By implementing practical tools and strategies both at work and in your personal life, you can better manage your migraine without allowing it to take over your day. Whether it’s creating a migraine-friendly workspace, keeping a migraine action kit handy, or knowing when to take a break, these proactive steps can help you stay productive, focused, and in control.