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Hormonal migraine: the basics

Migraines and Hormonal Changes in Women

Women are three times more likely to suffer from migraine than men. This 3 to 1 ratio of women to men does not occur until puberty. Before puberty, boys and girls have a similar rate of migraine attacks. At puberty, the female ovaries begin producing hormones, including estrogen and progesterone. The ups and downs in hormones that occur during the menstrual cycle are considered the main trigger for the increase in migraines in women compared to men.

Hormonal changes occur at menarche (when an adolescent begins menses); during monthly periods often referred to as menstrual cycles; pregnancy; post-partum (after delivery); perimenopause; and menopause. Hormonal changes can also occur when the birth control pill, patch or the contraceptive vaginal ring are used or if hormonal therapy such as estrogen is used for menopausal symptoms.

How do hormones cause migraines?

Estrogen, one of the female hormones produced by the ovary, has well-known effects on the way the brain functions. Estrogen also affects the way pain is perceived. For example the high level of estrogen during pregnancy is thought to help decrease the pain of childbirth. The decrease in estrogen that occurs just before menses is considered to be the main hormonal trigger for menstrual migraine. A landmark study done in the early 70’s looked at a group of women that had migraines with their periods (menstrual migraines). In this study, women were given estrogen by injection late in their cycle just migraines were delayed until the estrogen level dropped. When this same group of women was given an injection of progesterone late in their cycle, their bleeding was delayed but not their menstrual migraine. The results of the study pointed to the drop in estrogen as being the main hormonal trigger for menstrual migraine and not progesterone.

Significantly, during pregnancy when estrogen levels are high, many women experience marked improvement in their migraines. However, at the time of delivery, estrogen levels drop dramatically and often cause a lot of migraines during the post-partum time. During perimenopause, often referred to as the “change before the change”, when hormones are fluctuating dramatically, there is often a worsening of migraines. The typical age of perimenopause is 47-51 but it can last until 55 or when a woman stops having menses. Fortunately, many women experience major improvement of migraine during menopause. Therefore, the ups and downs in hormones, especially estrogen, appear to be a huge trigger for migraine attacks in women. At menopause, when the ovaries stop producing estrogen and progesterone, the hormonal trigger is no longer present from a woman’s own ovaries.

Menstrual Migraine

Over 50% of women with migraine experience migraine attacks with menses. If a woman has a migraine during the time frame of 2 days before menses to 3 days into her menses (often called -2 to +3 of the cycle; Day 1=first day of menses) and notices this pattern in at least 2 out of 3 cycles, then she would be considered to have menstrual migraine. Women with menstrual migraine are more likely to suffer from migraine without aura, have more severe and longer-lasting migraines, and suffer more disability with their menstrual migraines than migraines occurring at other times of the month.

Menstrual migraine can be further broken down into menstrual related migraine (MRM) and pure menstrual migraine (PMM). Most women with menstrual migraine have migraines at other times of their cycle from other triggers such as stress or lack of sleep; this group has menstrual related migraine. A smaller number of women experience migraines only with menses and not at any other time of their cycle; these women have pure menstrual migraine. Why is this important? Distinguishing between menstrual related migraine and pure menstrual migraine can help with treatment. Women with pure menstrual migraine can focus on treatment regimens targeted to their menses; women with menstrual related migraine need to be aware of all their triggers and may need a daily preventive treatment plan to help prevent all their migraine attacks.

Keeping a migraine journal is essential to diagnosing menstrual migraine. The first and last day of menses should always be marked on the calendar in addition to listing all headaches. In addition, any change in hormones, including a change in birth control, should always be noted. Some hormonal treatments may help menstrual migraine; some may worsen menstrual migraine.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • L. Kersten
    6 years ago

    For 25 years now, i’ve been suffering from migraines about once every 4 weeks. The first time was when I started with triginon anticonception (start of 3rd phase). After a few months I switched to a diferent type of anticonception pill. Nothing changed with respect to the migraine. When I stopped the anticonception, again, nothong changed. Every month around my period I had a migraine. Even during pregnacy. Because of endometrioses, I’m on hormones again ( Cerazette). No matter what, I have a migraine about every 4 weeks… 🙁

  • Pen Ort
    7 years ago

    I never had a migraine before peri menopause. Now 5 years past my periods they are 3/4 days a week. No triggers. No genetics. Presumably no hormones. Why am I still having them. They have ruined my life. I am housebound.

  • Donna Lenning
    8 years ago

    I’ve been having alot of migraines this past montghteeh and so has my daughter. Could change in weather be a problem? I suffer from complicated and hemiplegic migraines which makes my face droop and have temporary paralysis. It sucks!

  • Karen Neifer
    8 years ago

    Hormonal/menstrual migraines have been part of my life for years now. I have tried various medications and even nerve blocks and so far nothing has been successful in preventing or treating these. At my last neurology appt I was told that I may just have to learn to live with them. I find this unacceptable…I am literally out of commission for 3-6 days a month.

  • Chandler Marrs
    8 years ago

    Hi all, we’re devoting an blog issue to menstrual migraine series beginning October 24th and are looking for women who suffer from hormone-triggered migraines to share stories. We think it’s important to talk about these issue, so that other women can learn. We also regularly cover other hormone-related stories. Check us out. http://www.lucinebiotech.com/hormones-matter/

  • Helen Williams Lopez
    8 years ago

    Are the so-called natural hormones you can get from a compunding pharmacy as likely to cause migraines as the premarin supplements?

  • Tracy Adkins
    8 years ago

    I have had severe problems with menstrual related migraines for many years. Most doctors I have seen are reluctant to test my hormones though. Is there a specific test I can ask my OBGYN for to find out about hormone-related treatments I can try?

  • Helen Williams Lopez
    8 years ago

    Sorry to burst your bubble bt I have been without ovaries since I was 27 (I’m 59 now) and because of Hormone replacement therapy my migraines have never decreased and actually increased in intensity on hhormone therapy than when I was younger. 🙁 I take a veery minimal amount of hormones because of severe headaches if I increase the dose.

  • Angie Leblanc
    8 years ago

    I have suffer for 12 years now with these migraines,, And I have been going though perimenopause now and the months that I don’t have a period I don’t have the migraines Its been so nice , because I don’t have the ups and down of the hormornes. I cant wait to finish with this and hopefully I can have a life back that I have been missing out on! I will be 50 in 6 months. I didn’t have a period for 5 months last year and so far 4 months this year How much do you think I have? I so want my life back It has been hell for 12 years with these Migrianes. good Luck to all of you who Suffer I know how you feel! replax helps me.thank you.

  • Chandler Marrs
    8 years ago

    Hi Angie, we’re devoting an blog issue to menstrual migraine series beginning October 24th -would love to have you share your story. We also regularly cover menopause stories. Check it out. http://www.lucinebiotech.com/hormones-matter/

  • Trudii Peters Janzen
    9 years ago

    out of desperation I tried estrogen and progesterone.Im 45 now.was on it for a year.totally messed me up.prds were irregular.tried a variety of doses, with estrogen and without.Im from Canada.absolutely no way my dr or any other drs I asked including my neurologist, would even agree unless a hysterectomy was needed, not just for migraines.Ive been diagnosed with hemicrania continua…whatever! migraines are rampant and like a stalker, striking at any time.but are always way worse leading up to my prd.am also doing botox for past 6yrs.most relief Ive gotten but of course its not enough, but Ill take it.costs 600 every 5months or more often depending on numbness in forehead wearing off.no wrinkles on forehead is at least a good side effect for a miracle change!

  • Sharon Elizabeth Yocum
    9 years ago

    I can count on my hands the number of menstrual migraines I didn’t get. They are the worst! I wish there was a way to prevent them.

  • Dianne King
    9 years ago

    I Had a complete histerectomy in my 30’s and am now 66 and still experiece monthly migraines.

  • Sally Colby Scholle
    9 years ago

    Also…had hyster at age 52 but retained ovaries, so I don’t have a clear time frame for complete meno. I’m now 57 and still have ~ 2-4 migraines/week. I know one definite trigger is fluorescent lights (the imperceptible flickering?), not sure what else.

  • Jodi Heethuis
    9 years ago

    When I started topomax my doc knew I would have to have an increased dose, started at 25mg and take 100mg to be effective. I too have to try several meds to find something that works! Good luck, they suck . I have spent lots of time in ER puking getting IV’s and shots!

  • Debra Nemeth
    9 years ago

    I have tried topomax=no effect, then tried seropuel…gained 20 lbs in 2 weeks, fluid retention …had to stop that men. Im hoping the 2nd round of botox (given 1 time every 3 months wil be the ticket.

  • Jodi Heethuis
    9 years ago

    Have you tried topamax to prevent them, it has been my miracle drug!

  • Debra Nemeth
    9 years ago

    I have had a complete hysterectomy as well. I am taking premarin. My migraines are more intense and more frequent. I received botox injections March 1st. I have had only 2 days of ZERO headaches. The change in weather definitley affects me….but I also notice this: towards the end of the month, my face starts getting acne and hair frows in unusual places on my face…. AND … migraines are intense. ??

  • Dianne King
    9 years ago

    the blinking lights does it to me too and also fioricet does help me but at age 66 i would think after complete hyster my body would realize its done and over I dont quite understand

  • Sally Colby Scholle
    9 years ago

    So it makes sense that my migraines started during perimenopause, and were relieved with the use of short-term HRT? I’ve stopped taking HRT due to agreement with Dr (very strong history of first-degree relatives with BC), but still experience migraines. Thank goodness Fioricet works most of the time.

  • Sarah Wallace Smith
    9 years ago

    I used to have bad cluster migraines all the time. Since I had my left ovary removed in July, 2010, along with a baseball-size serous cystadenoma, I have had very few and less severe migraines. They could not find my right ovary and also removed many adhesions by DaVinci robotics. I had my uterus removed about 20 years ago. I am now 56.

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