Normal NOT Normal
Period Migraine: How To Know If Your Pain Is Normal
Period migraines are more than just “bad headaches”—they can be intense, recurring, and deeply disruptive.
If the headache consistently strikes a day or two before your period and comes with nausea, light sensitivity, or throbbing on one side, you might be dealing with a menstrual migraine. While some discomfort during menstruation is normal, frequent or severe migraines that interfere with your daily life could be a sign to seek medical advice.
Tracking your symptoms can help distinguish typical hormonal headaches from something that needs further evaluation.
What’s normal and what’s not?
Period migraines can feel different for everyone. Some women experience just a bit of discomfort, while others face intense pain that can mess with their day-to-day routine.
Non-migraine headaches that are an emergency or atypical, and require medical consultation1
Non-migraine headaches like:
Tension headache: Headache that feels like a tight band wrapped around your head.
Cluster headache: Unilateral headache occurring in clusters, meaning there are pain-free period in between the attacks. Severe one-sided pain behind or around the eye.
Thunderclap headache: Sudden headache that reaches the maximum intensity in less than a minute and lasts for almost 5 minutes. Describes ad worst headache ever.
Secondary headaches: Headache that is caused by another underlying condition.
Red flag symptoms that are an emergency or atypical, and require medical consultation
Change in headache pattern or ‘worst headache ever’
Neurological signs/seizure
New onset at 50+ years
Persistent after exercise or Valsalva maneuver
Progressively increasing severity
Systemic symptoms - fever, hypertension, myalgia, weight loss
Thunderclap onset (max severity at onset)
The scales to measure period migraine
There are several tools and scales that healthcare professionals use to assess the severity of period migraine. These methods help to categorize the pain, so patients and doctors can determine the appropriate course of action.2
Here are the most commonly used scales:
1. MIGRAINE DISABILITY ASSESSMENT SCALE (MIDAS)
In 1999, Stewart and Lipton developed the Migraine Disability Assessment Questionnaire (MIDAS), a 5-item questionnaire designed to evaluate disability within the most recent 3 months.
The patient needs to score the reduction in the performance, in days, of work/school, household work, and family/social activities.
A score of 0–270 is used to indicate the overall level of disability due to headaches based on the following grading system:
Grade I, little or no disability: score of 0–5
Grade II, mild disability: score of 6–10
Grade III, moderate disability: score of 11–20
Grade IV, severe disability: score of ≥ 21
Recently, in order to better characterize headache-related disability due to chronic migraines, grade IV (MIDAS ≥ 21) was further divided into:
Grade IV-A: MIDAS 21–40
Grade IV-B: MIDAS ≥ 41
2. HEADACHE IMPACT TEST (HIT-6)
The Headache Impact Test (HIT-6) is also a widely validated instrument used to measure the functional impairment of headaches. The HIT-6 comprises six items to evaluate the frequency of severe headache, limitations of daily activities (including work, school, and social), desire to lie down, fatigue, irritability, and difficulty concentrating.
Each of the six items is scored according to frequency, generating an overall score of 36–78.
The impact scores can be classified as:
Little or no impact (Grade 1): score 36–49
Moderate impact (grade 2): score 50–55
Substantial impact (grade 3): score 56–59
Severe impact (grade 4): score 60–78
Except for disability reduction, improvement in HRQoL (Health-Related Quality of Life) also serves as a major goal during the treatment of migraines. The most commonly used instruments for assessing HRQoL are:
3. MIGRAINE-SPECIFIC QUALITY OF LIFE QUESTIONNAIRE VERSION 2.1 (MSQ v2.1)
MSQ v2.1 is a 14-item questionnaire used to assess the limitations in daily performance due to migraine.
MSQ v2.1 is composed of three domains:
Role function-restrictive (RR)
Role function-preventive (RP)
Emotional function (EF)
The first two of these domains are used to access the reduction and prevention of daily social- and work-related activities, while the last domain is used to evaluate emotions associated with migraine.
Raw dimensional scores are computed as a sum of the item responses and rescaled to 0–100, where higher scores indicate better HRQoL.
4. EUROPEAN QUALITY OF LIFE-5 DIMENSIONS (EQ-5D)
EQ-5D is a self-reported health status that covers five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and general health status.
The health status of the five dimensions is presented as an index 0–1, where 1 is the best.
5. SHORT-FORM 36 (SF-36)
SF-36 is a multidimensional questionnaire used to assess the impact of disease on eight health domains, including physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health.
A score of 0–100 on each subscale is generated, with higher scores indicating better HRQoL.
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