The answer

Lauren sounds to be suffering from menstrual migraine, a condition associated with the dramatic drop in oestrogen that happens just before a period and the release of prostaglandins during the first 48 hours of menstruation. In its guidance on the diagnosis and management of headaches in over 12s, the National Institute of Health and Care Excellence (NICE) states that menstrual-related migraine should be suspected in women and girls whose migraine occurs predominantly between two days before and three days after the start of menstruation in at least two out of three consecutive menstrual cycles.

Vicky could recommend that Lauren keep a headache diary for a few months to see if this is, in fact, the case. It also has the benefit of helping Lauren feel a bit more in control of the condition, and providing a way of demonstrating the impact it has on her life should she decide to seek medical assistance.

Assuming it is menstrual migraine that Lauren is experiencing, there are several potential treatment options. If Lauren is experiencing heavy periods as well as the headaches, the non-steroidal anti-inflammatory drug (NSAID) mefenamic acid might be a good course of action to try, whereas a hormonal contraceptive may be an option if she is after a more regular menstrual cycle and requires birth control. Anti-migraine medication such as triptans are another possibility.

Self-help measures that may prevent a migraine occurring include eating small frequent snacks to keep blood sugar levels stable, avoiding missing meals, having a regular sleep pattern, and minimising stress.