For Health Practitioners

Bad Headache or Migraine

Bad Headache or Migraine

Bad Headache or Migraine

You may be surprised that information on headaches and migraine are included on this site, but they are quite common in people with pelvic pain.

Talking about your headaches with your doctor first is always best, as serious disease is possible. There are many types of headaches, and if you are unsure what type of headache you may have, you will find information to help you at:

Remember to tell your doctor straight away if:

  • Your headaches have changed or become worse
  • A headache comes on suddenly
  • You have a stiff neck or fever
  • Your headache started after an injury
  • You have new sensations, weakness or abnormal movements

Headaches and Pelvic Pain

Two types of headache that do seem to be particularly common in people with pelvic pain are:

  • low-grade background headaches that may represent chronic inflammatory changes in the body that drive chronic pain and headache.
  • migraine headaches that are more common in women than men.

Migraines are probably more common in women because of hormonal differences. One common trigger for migraine is the changes in oestrogen level with periods. It may also be that oestrogen hormones prime pain pathways to make headache more likely. On average, women with endometriosis seem to have even more severe and troublesome migraines than other women.

Girls and boys have fairly similar rates of headache until puberty, but after puberty, three times as many girls are affected as boys.

It is often overlooked that children can get migraines too.

Migraines with periods (Menstrual Migraine)

None of these treatments suits everyone, so you may need to try more than one to find something that suits you best. It is worth the effort, though. Your headaches are unlikely to go away by themselves, and life is better without headaches.

Headaches with periods

A headache that comes each month with a period often improves with one of these options:

  • an IUD in the uterus
  • a diclofenac 100mg suppository
  • a ‘triptan’ nasal spray available from your doctor, or,
  • an estrogen hormone patch used at period time

A low-grade headache for several days each month

Sometimes they may be severe, while at other times, they are just a nuisance. It is worthwhile trying a preventer medication taken every day. Helpful medications for young women include:

  • Amitriptyline 5-25mg 3 hours before bed each day
  • Cyproheptadine (Periactin), 2 to 4mg each night
  • Other medications from your doctor or explained in our book

Try each one for 2-3 months and keep a headache diary to decide if it has helped.

Migraines at other times

Make a plan with your doctor and ask about a ‘triptan’ nasal spray.

There is much more information on headaches in our book and at

Unfortunately, this has led to some women having drastic hormonal and gynaecological manipulation, generally with poor results. For most patients, hormonally related migraine is still best treated in a conventional manner using the types of migraine treatment used for most patients. However, in some instances, collaboration between a headache specialist and a gynaecologist can produce the best results. For some women with migraine, the attacks are much more likely to occur around the beginning of the period than at other times, called menstrual migraine. It seems to be triggered by the drop in the blood levels of the female hormone oestrogen around the time of the period. This can be partly helped by hormonal treatment, which may include the oral contraceptive but needs to be managed carefully as it may also worsen the condition. It is not clear why headache may be more common in patients with chronic pelvic pain. However, current research at the University of Adelaide suggests that there is a low grade of inflammation in the brain which predisposes to chronic pain and these can drive both chronic pelvic pain and headache. It is possible that treatment directed at this mechanism might help both conditions.

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