Migraines, Headaches, and Hormones

For women, migraine headaches can be tied to shifts in the levels of the female hormone estrogen.

Your estrogen, as well as progesterone, levels drop right before the start of your period, so you may get headaches then, too.

As early as 1966, researchers noticed that migraines may be worse for women who take birth control pills, especially ones with high doses of estrogen. Pills with lower estrogen doses or with progesterone cause fewer side effects.

Hormone replacement therapy during menopause can also trigger migraines.

Treatment

A nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen may be enough to stop a menstrual migraine. Your doctor can prescribe stronger NSAIDs. Mefenamic acid (Ponstel) works on the migraine symptoms as well as period cramps.

Drugs called triptans that are used to treat migraines and cluster headaches can also treat menstrual migraines. They shrink blood vessels and fight pain.

You'll probably need to take medicine 1 to 2 days before your period starts until it's over. Some women need to take both a triptan and an NSAID.

Prevention

Some birth control methods, like pills, patches, or vaginal rings, can help cut the number or the severity of menstrual migraines. You may need to try different types with different combinations and doses of hormones to find what works for you. Or your doctor may suggest using birth control continuously for a while, without a break for a period, to avoid headaches.

But if you have migraines with aura, you shouldn't use hormonal birth control because of a greater likelihood of strokes. Even if you don't have auras, your doctor may not want to prescribe birth control if you're over 35 and you smoke, have high blood pressure or cholesterol, are more than a little overweight, or have diabetes.

Naproxen and the triptans frovatriptan (Frova) or zolmitriptan (Zomig), which treat menstrual migraines, may also help prevent them.

Taking a magnesium supplement might make your headaches shorter and your periods easier. But talk to your doctor before you start using it.

It's also a good idea to limit how much salt you eat before your period starts so your body doesn't hang on to water in your tissues, which could create extra pressure. Your doctor can prescribe "water pills" (diuretics) to help you pee out extra fluid and bring down swelling if it's a problem.

If nothing else works, leuprolide acetate (Lupron) drops estrogen levels. But there can be unpleasant side effects because it's affecting the balance of your hormones.

Continued

During Pregnancy

These hormonal migraines often go away while you're pregnant. You might still get headaches during your first trimester, but they usually stop after the third month.

Avoid taking any medicine for your migraines during pregnancy. You might try a mild pain reliever, like acetaminophen, but check with your doctor to make sure it's safe for you before you take it.

Menopausal Migraines

For many women, migraines get better once their periods have finally stopped.

If you're on estrogen replacement therapy and your migraines get worse, your doctor may lower the dose, prescribe it in a different form, or have you stop it altogether.

An estrogen patch (like Estraderm) can keep levels of the hormone steadier, so you're less likely to have bad migraines.

WebMD Medical Reference Reviewed by Neil Lava, MD on July 14, 2016

Sources

SOURCES:

American Headache Society: "Menstrual Migraine: New Approaches to Diagnosis and Treatment."

Cleveland Clinic: "Hormone Headaches Menstrual Migraines."

UpToDate: "Estrogen-associated migraine."

Migraine Trust: "Menstrual migraine."

Mayo Clinic: "Chronic daily headaches."

Medscape: "Oral Contraceptives in Migraine."

Hu, Y. The Journal of Headache and Pain, Jan 30, 2013.

 

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