Migraine Trigger: Hormonal Changes

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Hormones are powerful chemicals the body uses to control many functions. Hormones also play a large role in women with migraine. In fact, more than 8 out of 10 people with chronic migraine are women.1

Women have hormonal changes that may trigger migraine when they:2

  • Begin menstruating (called menarche)
  • At the start of their monthly menstrual cycle
  • At the end their monthly menstrual cycle
  • Use birth control pills, patches, shots, etc.
  • Are pregnant
  • Soon after pregnancy (postpartum phase)
  • During perimenopause and menopause
  • Use hormone replacement therapy

What causes hormonal migraines in women?

Doctors know that the hormone estrogen plays a strong role in triggering migraine in women. One in every 4 women will have a migraine at some time during their life. Generally, a migraine is triggered when estrogen levels rise and fall in a woman’s body.2

For example, many women have their first migraine around the start of their first period. Later, many women feel a migraine begin anywhere from 2 days before to 3 days after their period. Pregnancy and menopause are other common times when hormonal changes trigger migraines. Breastfeeding seems to prevent migraine during the postpartum period in some women.3

How is menstrual migraine treated?

A migraine journal can help you find patterns for when you develop a migraine during your menstrual cycle. For some, taking an NSAID pain reliever (such as ibuprofen) or triptan a few days before the start of their period helps prevent a migraine. Other women find it helps to take birth control pills and skip the placebo week (the different-colored pills that make you menstruate). This keeps your hormones level.3

How is it treated during pregnancy and while breastfeeding?

Between 50 and 80 percent of women have fewer migraines while pregnant and breastfeeding. However, if a woman still has a migraine at these times, treatment can be hard.4

Many migraine treatments are not safe, or have unknown safety, for an unborn baby. Small doses of acetaminophen (Tylenol) are thought to be safe. Some migraine drugs may be safe during certain trimesters. It is always better to talk with your doctor before taking any migraine drugs if you are pregnant or breastfeeding.4

Non-drug migraine treatments also play an important role during pregnancy and breastfeeding. Examples include yoga, massage, drinking plenty of fluids, and extra rest. Anything that can help a woman manage pregnancy’s muscle tension, stress, and lack of sleep can help prevent a migraine.1,4

How is treated during menopause?

Menopause is a long process in which the female body slowly becomes less fertile until the woman cannot become pregnant. The time leading up to full menopause is called perimenopause.

Estrogen levels rise and fall before reaching low levels during perimenopause. These changes can trigger migraine attacks. Hormone replacement therapy, especially the hormone patch, helps keep hormones more stable. This can reduce the number of migraine attacks. However, hormone replacement is not for everyone, such as women who have migraine with aura or heart disease.5

Other migraine treatments during perimenopause include certain anti-seizure and antidepressant drugs, and natural supplements. The good news is that many women find they have fewer migraines after menopause.2

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