Around ovulation your oestrogen peaks and then falls again. Because a falling oestrogen can trigger headache, "ovulation migraine" sounds logical. Yet in the largest Dutch cycle study so far, 563 women across 2,627 cycles, that post ovulatory rise was not found (Cephalalgia, 2026).
The researchers themselves expected to see it. That is exactly why the result is worth reporting.
Before you read on: this does not mean your headache is not there, or that you are imagining it. It means the explanation you meet everywhere is probably not the right one. That is useful, because a wrong explanation sends you in the wrong direction.
What exactly was measured?
Researchers followed women with migraine through an electronic diary and recorded per cycle day whether an attack occurred. Then they compared the phases against each other. The perimenstrual window stood out strongly. The window directly after ovulation did not.
| What you usually read | What was measured across 2,627 cycles |
|---|---|
| Migraine risk rises after ovulation | No increase found (OR 0.95, not statistically significant) |
| Menstruation is one of several risk moments | That window stood out by far the most (OR 1.67) |
| After your period you are out of the danger zone | The follicular phase still ran about a third higher than the luteal (OR 1.31) |
That third row is almost never mentioned and may be the most useful. The week after your period is calmer than the period itself, but not yet as calm as the second half of your cycle.
So why does the ovulation explanation not hold?
Because the drop after ovulation behaves differently. After the peak your oestrogen does fall, but less deeply and less abruptly than at the end of your cycle, and your progesterone rises across it at the same time. The perimenstrual fall is sharper and comes without that counterweight.
If the speed of the drop is what counts, and most research points that way, that explains the difference.
On top of that, the oestrogen withdrawal hypothesis itself is less firm than commonly assumed. A 2023 critical review concluded that the evidence is limited, with small groups and inconsistent definitions (PMID 37730536). So we know more about the pattern than about the cause.
What your oestradiol does in which phase is explained in oestradiol levels.
Does this mean headache around ovulation does not exist?
No, and that is an important difference. The study looked at migraine attacks in women with migraine. It did not look at all headache in all women. Tension headache, headache from poor sleep, or headache alongside mid cycle pain fall outside it.
A study that does not measure something has nothing to say about it.
What it does do is weaken the most commonly used explanation. If your headache lands tight around ovulation, the chance that the oestrogen dip is the trigger is smaller than assumed. Then it is worth looking at other things in those same days: sleep, pressure, a shifted rhythm.
Around ovulation some women also have mid cycle pain, mild nausea or tender breasts. Those symptoms can occur together without one causing the other.
How do you find out where your headache actually sits?
By recording the cycle day instead of estimating the phase. Many women say "around my ovulation" based on feel, and on tracking turn out to be on day 22 or day 26. That is a different story with a different explanation.
Always count from the first day of your period. That is day 1.
Take two women with a 28 day cycle who both suspect "ovulation migraine". On counting, one turns out to sit on day 14, the other on day 26. Those are two completely different stories, with two different explanations. And you only see it once you note the day.
For three cycles, note the cycle day, the duration, whether nausea came with it and whether you saw shimmering beforehand. If on reflection the attacks do sit against your period, read menstrual migraine. If it genuinely stays mid cycle, that is valuable information for your GP, precisely because it falls outside the known pattern.
Does blood testing add anything here?
Not for the headache itself. No blood value shows migraine or tension headache, and a hormone value on a random day says little about your attacks. What blood testing can do is look at causes that are not cyclical but do produce headache.
Iron deficiency and an underactive thyroid are the two most often missed.
With a hormone profile, your cycle day also counts. An oestradiol on day 3 means something different from one on day 21, and without that date the result is hard to read. Which hormone test fits which day is in hormone testing in women. If you want that picture taken, hormones for women fits it.
For the iron side, headache from iron deficiency is the follow up. The full cycle explanation is in hormonal headache.
Discuss any result outside the range with your GP. Contact them promptly for headache that reaches full force within seconds, fever with a stiff neck, or neurological symptoms that do not resolve.
References
- van der Arend BWH, Bakker S, van Casteren DS, et al. Migraine attack incidence in relation to the post-ovulatory estrogen decline: a prospective cohort study. Cephalalgia. 2026. doi:10.1177/03331024261436415.
- Raffaelli B, Do TP, Chaudhry BA, Ashina M, Amin FM, Ashina H. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. J Headache Pain. 2023;24(1):131. PMID 37730536.
- Reddy N, Desai MN, Schoenbrunner A, Schneeberger S, Janis JE. The complex relationship between estrogen and migraines: a scoping review. Syst Rev. 2021;10(1):72. PMID 33691790.
- Thuisarts. Migraine. Available via thuisarts.nl.
- RIVM and VZinfo. Migraine: figures and context. Available via vzinfo.nl.
Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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