Migraine and Hormones in Women

Women who get migraines often notice that they’re likely to hit just before or during their period. These headaches are called menstrual migraines.

They’re tied to changes in hormone levels just before a period starts. Your levels of estrogen, as well as progesterone, drop right before the start of your period. That’s when migraines are most likely.

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. Most forms work this way: You take pills that mix the two hormones for 3 weeks. For the week of your period, you might take placebo pills or no pill at all. That sudden drop of estrogen can also lead to migraines. Talk to your doctor about pills with low amounts of estrogen or progesterone only. They cause fewer side effects.

Hormone replacement therapy, a type of medication many women use during menopause to control hormone levels, can also trigger migraines.

Treatment

An over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen may be enough to stop a menstrual migraine. Your doctor can prescribe stronger NSAIDs. Many treat migraine symptoms as well as period cramps.

Drugs called triptans, which treat migraines and cluster headaches, can also treat menstrual migraine. They affect the release of certain brain chemicals and block pain pathways in your brain.

You'll typically take them for a few days before your period starts and continue them for about a week. Some women need to take both a triptan and an NSAID.

Another possible option is a neuromodulation device that you put on your head, neck, or arm at the start of a headache. These can often bring relief from migraine pain.

Prevention

Some birth control methods, like pills, patches, or vaginal rings, can help cut the number of menstrual migraines you have or how severe they are. 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 without a break for a period.

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But if you have migraine 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 (Aleve, Naprosyn) and the triptans most often used to treat menstrual migraine may also help prevent them. If you don’t respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You can take these regularly to have fewer of the headaches or make them less severe. These could include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants.

CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help. Nonmedical options include magnesium supplements and even acupuncture.

Check with your doctor before using any supplements, as they are not regulated like prescription medicines and may have ingredients that are not safe.

Four devices could help prevent migraines. A small headband device called Cefaly helps prevent migraines in some people. It sends electrical pulses through the forehead to stimulate a nerve linked with migraines.

SpringTMS is a small magnet that can be placed on the back of your head when a migraine starts. Split-second pulses interrupt the electrical activity migraine brings. This can end or prevent a migraine.

GammaCore is a handheld device that is placed on the side of the neck above where you can feel your pulse. It sends mild electrical pulses to stop migraine pain. But it’s not intended to prevent migraines.

Nerivo is a remote electrical neuromodulation (REN) device controlled through an app on a smartphone. It is worn as a band on the upper arm and sends weak electrical pulses to keep migraine pain from developing.

During Pregnancy

These hormone-driven migraines often go away while you're pregnant. You might still get headaches during your first trimester, but they usually stop after that. Other [1] women may have migraines for the first time during pregnancy.

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While most headaches in pregnancy are harmless, some can be signs of more serious concerns such as preeclampsia.

Call your doctor:

  • Before taking any medicine for your headache
  • If your headaches get worse or do not go away after you take acetaminophen
  • If the headache is sudden or explosive, or if you also have a fever and stiff neck
  • If you have symptoms of preeclampsia in your second or third trimester, such as vision changes, swelling, or pain in the upper right abdomen

Menopausal Migraine

For many women, migraines get better once their periods have 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 tell you to stop it altogether.

An estrogen patch can keep levels of the hormone steadier than the pill form of the hormone, so you're less likely to have bad migraines. 

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 10, 2020

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."  

The Journal of Headache and Pain: “Triptans in prevention of menstrual migraine: a systematic review with meta-analysis.”  

UpToDate: "Preventive treatment of migraine in adults.”  

American Headache Society: “Menstrual Migraine.”  

Harvard University Graduate School of Arts and Sciences: “Taming The Cycle: How Does the Pill Work?”   

Journal of Headache Pain: “Migraine in women: the role of hormones and their impact on vascular diseases.”

American Migraine Foundation: “Spotlight On: Neuromodulation Devices for Headache.”

GammaCore: “Instructions for Use for GammaCore Sapphire.”

March of Dimes: "Your Pregnant Body: Headaches."

National Headache Foundation: "Pregnancy and Migraine."

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