Migraine and Hormones in Women

If you’re a woman who gets migraines, you may have noticed they’re likely to hit either just before your period or right after. This headache is called menstrual migraine.

They’re tied to changes in hormone levels just before your 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 probably need to take medicine  about 1 to 2 days before your period starts for up to a week. Some women need to take both a triptan and an NSAID.

Another possible option is a new handheld device called gammaCore. It is a noninvasive vagus nerve stimulator which can be placed on the neck to bring relief from migraine pain.

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.

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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 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 reduce the severity or frequency of the headaches. 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 they may contain substances that are not safe.

In addition, there are three devices that could help prevent migraines. A small headband device called Cefaly has found to be helpful in preventing 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 then interrupt the electrical activity migraine brings. As a result, your migraine ends.

GammaCore is a handheld device that is placed on the side of the neck above where you can feel your pulse. There it sends mild electrical stimulation to the vagus nerve, which communicates with your brain to end the migraine.

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.

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. 

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Menopausal Migraine

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 tell you to stop it altogether.

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

WebMD Medical Reference Reviewed by Lawrence C. Newman, MD on January 09, 2019

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.   

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.”

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