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Migraines, Headaches, and Hormones

If you’re a woman who gets migraines, you’ve probably noticed they’re likely to hit just before your period. These headaches are called menstrual migraines.

What’s the Link Between Hormones and Headaches?

Headaches in women, particularly migraines, are tied to shifts in the levels of the female hormone estrogen during your menstrual cycle. Estrogen levels drop right before the start of your menstrual flow.

Premenstrual migraines regularly happen during or after the time when the female hormones, estrogen and progesterone, drop to their lowest levels.

Migraines often go away during pregnancy, especially if they’re tied to your period. Or you might get headaches during the first trimester, only to have them vanish after the third month of pregnancy.

What Triggers Hormonal Migraines in Women?

Birth control pills as well as hormone replacement therapy during menopause can trigger migraines in some women. 

As early as 1966, investigators noted that migraines may be worse for women taking birth control pills, especially those with high doses of estrogen. Pills with low doses of estrogen and those with progesterone cause fewer side effects.

How Do You Treat Menstrual Migraines?

Nonsteroidal anti-inflammatory medications (NSAIDs) are the medications of choice to stop a menstrual migraine.

The NSAIDs most often used for menstrual migraines include:

  • ibuprofen (Advil, Motrin), ketoprofen (Orudis)
  • fenoprofen calcium (Nalfon), naproxen (Aleve, Naprosyn)
  • nabumetone (Relafen)

Your doctor may tell you to begin treatment 1 to 2 days before your period starts and to keep taking it until the period's over.

Other drugs are given by prescription only. They include:

  • Small doses of ergotamine drugs (Bellergal-S, Cafergot, Migranal)
  • Beta-blocker drugs such as propranolol (Inderal)
  • Anticonvulsants such as divalproex sodium (Depakote), valproate (Depacon)
  • Calcium channel blockers such as verapamil (Calan, Covera-HS)

Your doctor will likely tell you to start one of these drugs a couple of days before your period, and take it until the period ends.

Your doctor may suggest a diuretic during your period. He may also tell you to limit how much salt you eat before your period starts.

If you still can’t get relief, your doctor might suggest a drug that affects hormone levels, leuprolide acetate (Lupron).

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