---
title: Can cluster headache happen before menstruation? | Niyora
description: Yes. A 28-year-old woman had severe one-sided headaches starting only in the weeks before her period, which was initially mistaken for migraine. When treated
url: https://niyora.com/research/papers/cluster-headache-with-perimenstrual-trigger-mimicking-chronic-migraine-a-case-2025/
---

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- Can cluster headache happen before menstruation?

Case report, 2025

# Can cluster headache happen before menstruation?

Yes. A 28-year-old woman had severe one-sided headaches starting only in the weeks before her period, which was initially mistaken for migraine. When treated with oxygen and verapamil, the headaches stopped.

 Early or limited evidence

28-year-old woman

## What they did

Doctors described one 28-year-old woman who had severe right-sided headaches lasting 60-90 minutes that happened in 4-6 week episodes, always triggered by the time before menstruation.

## What they found

The woman had cluster headache (not migraine) triggered by the premenstrual phase. When treated with high-flow oxygen and verapamil, her headaches stopped completely.

## What it means for you

Severe cyclical headaches can sometimes be cluster headache, not migraine. This matters because treatments are very different. The main limit is that this is one woman's experience, so we don't know how often this happens in other women.

28

age

60-90

minutes per headache

4-6

weeks of headache episodes

## About the study

Original title Cluster headache with perimenstrual trigger mimicking chronic migraine: a case report and diagnostic challenge Authors Christian Gonçalves Journal Headache Medicine/Revista Headache Medicine Year 2025 Study design Case report What was tested High-flow oxygen and verapamil Open access Yes Read the paper [doi.org/10.48208/headachemed.2025.26](https://doi.org/10.48208/headachemed.2025.26) Original abstract

IntroductionCluster headache (CH) is a trigeminal autonomic cephalalgia known for its excruciating unilateral pain and strong male predominance. Its triggers are rarely hormonal, contrasting with migraine, which is frequently modulated by the menstrual cycle. This discrepancy creates a potential for diagnostic confusion in female patients.Case reportA 28-year-old woman presented with a two-year history of excruciating, right-sided periorbital attacks lasting 60-90 minutes. Bouts occurred for 4-6 weeks, exclusively triggered premenstrually. She exhibited prominent psychomotor agitation and ipsilateral autonomic symptoms. Initially diagnosed as refractory menstrual migraine, she was unresponsive to standard migraine treatments. A detailed anamnesis led to a revised diagnosis of episodic CH.DiscussionThe menstrual trigger, typical of migraine, masked a classic CH presentation, leading to a diagnostic delay. The correct diagnosis was established by focusing on attack phenomenology, particularly the patient's behavior (agitation vs. rest) and autonomic signs. The patient achieved complete resolution of attacks with high-flow oxygen and verapamil. This case highlights how gender and trigger-related biases can impede correct diagnosis and reinforces the need to consider CH in women with cyclical headaches

Reproduced under CC-BY.

## Topics

[Pain and headache](https://niyora.com/research/topics/symptom-pain/)[Migraine](https://niyora.com/research/topics/comorbidity-migraine/)

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