Hormonal Headaches and Menstrual Migraines

Several types of headaches are linked to changing levels of the hormones estrogen and progesterone. Women often get menstrual migraines anywhere from 2 days before their period to 3 days after it starts. But anything that changes these hormone levels can cause them. The degree to which those levels shift, not the change itself, determines how severe they are.

Causes

Birth control: The pill can make migraines worse for some women and lessen them for others. Three weeks out of every month, they keep the hormones in your body steady. When you take placebo pills or no pills at all, during the week of your period, your estrogen levels plummet and your head can pound. If you’re prone to hormonal migraines, taking birth control that contains low amounts of estrogen or only progestin may help.

Hormone replacement therapy : This type of medicine women take during menopause to control their hormones can also set off headaches. An estrogen patch is less likely to make headaches worse than other types of estrogen, because it gives you a low, steady dose of the hormone.

Menopause: Once you stop having periods for good, you’ll probably have fewer migraines. If you’re on estrogen replacement therapy and your headaches get worse, your doctor may lower the dose, advise you to stop taking it, or change to a different type. An estrogen patch is often the best option. It keeps your estrogen level steady, so a menstrual migraine is less likely to happen. Some women notice that while migraines get better, tension headaches get worse during this time.

Menstruation: Does it seem like you always get migraines right around your period? You’re not imagining that the two are linked. About 60% of women with migraine get a type of headache called menstrual migraines. Right before your period, the amount of estrogen and progesterone, two female hormones, in your body drops. This drastic change can trigger throbbing headaches.

Perimenopause: In the years before menopause, estrogen levels go on a roller-coaster ride. Many women get both tension headaches, which result from stress, and migraines during this time.

Pregnancy: During the first trimester, estrogen levels rise quickly, then level out. Because of this, many women notice that their migraines get better or go away after their third month of pregnancy. If you still get headaches, don’t take any drugs. Many migraine medicines are bad for your baby. An over-the-counter pain reliever like acetaminophen should be safe, but check with your doctor before you take it.

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Symptoms

A menstrual migraine is much like a regular migraine. You’ll notice:

  • Aura before the headache (not everyone gets this)
  • Throbbing pain on one side of your head
  • Nausea
  • Vomiting
  • Sensitivity to light and sound

A PMS headache that comes before your period might have a few different symptoms:

Medical Treatments

NSAIDs: A non-steroidal anti-inflammatory drug like ibuprofen or is sometimes all you need to treat a menstrual migraine. You can buy these over the counter, or your doctor can prescribe a stronger version. Along with your migraine symptoms, these drugs can also relieve period cramps.

Triptans are another option. These drugs block pain signals in your brain. They can start to work as soon as 2 hours after you take them.

Your doctor may suggest that you take both an NSAID and a triptan to get relief.

If your period comes every month like clockwork, you can start these drugs a few days before your bleeding starts and continue for up to a week. This often prevents the migraine from coming on. If your period doesn’t always stick to a schedule, your doctor may suggest you try a different type of drug that will prevent a headache from happening in the first place.

gammaCore: This handheld device is also known as a noninvasive vagus nerve stimulator. (“Noninvasive” means it stays outside your body). You place it on a spot on your neck to bring relief from migraine pain.

Home Remedies and Alternative Treatments

Talk to your doctor about these options, especially supplements, which can affect the way other medications work:

  • Acupuncture. This ancient Chinese practice that involves inserting needles along energy points in your body may lower the number of tension headaches you get and could prevent migraines.
  • Biofeedback. Biofeedback may improve your headaches by helping you monitor how your body responds to stress. It may help with both tension headaches and migraines, but doctors aren’t exactly sure why.
  • Butterbur: This herb can lower the number of migraines you have and make the headaches less severe. Supplements can help, but they might cause belching and other mild tummy troubles. Be sure to look for the supplements that are free from pyrrolizidine alkaloids, which are known to cause liver damage and cancer.
  • Coenzyme Q10: This antioxidant, available as a supplement, may help prevent headaches.
  • Feverfew: This herb can prevent migraines, but supplements can cause aches, pains, and mouth sores.
  • Ice. Hold a cold cloth or an ice pack to the painful area on your head or neck. Wrap the ice pack in a towel to protect your skin.
  • Limit salt. Eating too many salty foods could also lead to headaches. It’s wise to limit the amount of salt you eat around the time of your period.
  • Massage. There’s some evidence that shows it can help ease migraines, but again, doctors aren’t exactly sure how it works.
  • Magnesium. Low levels of this mineral can lead to headaches. Supplements may help. But they can give you diarrhea.
  • Relaxation techniques. These include progressive muscle relaxation, guided imagery, and breathing exercises. They can’t hurt, and some experts say they help with headaches, but there isn’t a lot of solid proof.
  • Riboflavin. Also known as B2, this vitamin may help prevent migraines. It could also turn your pee an intense yellow.

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Can You Prevent These Headaches?

There are a few methods your doctor might suggest.

Hormonal : Birth control pills or estrogen patches and vaginal rings may help lower the number of menstrual migraines you have or make them less severe. But they don’t work for everyone. In some cases, they could make your migraines worse.

Your doctor might tell you to stay on birth control for 3 to 6 months without taking any placebo pills. This will prevent you from having a period and may stop your headaches.

If you get migraines with auras, using birth control that contains estrogen and progesterone isn’t a safe option. Taking it could make you more likely to have a stroke. Other reasons your doctor may not want you to take birth control for your menstrual migraines:

If nothing else works, your doctor may prescribe a drug called leuprolide acetate (Eligard, Lupron Depot). It drops the estrogen levels in your body, but it does have side effects. Because of this, it’s often thought of as a last resort.

Medicines that treat migraines: The drugs used most often to treat menstrual migraines can also help prevent them. These include NSAIDs and triptans, such as:

Medicines that prevent migraines: 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 make the headaches less severe or less frequent. These could include:

Devices: Two devices may bring relief.

  • Cefaly: This small headband device sends electrical pulses through your forehead to stimulate a nerve linked with migraines.
  • SpringTMS or eNeura sTMS: You place this magnet on the back of your head, and a split-second pulse interrupts abnormal electrical activity that could lead to a migraine.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on September 09, 2018

Sources

SOURCES:

National Headache Foundation: “Cut Back on Salt to Decrease Headaches,” “Menstrual Migraine.”

Mayo Clinic, “Chronic Daily Headaches,” "Headaches and hormones: What’s the connection?”

Harvard University: “Taming the Cycle: How Does the Pill Work?”

OBG Management: “The gynecologist’s role in managing menstrual migraine.”

Cleveland Clinic: “Hormone Headaches Menstrual Migraines,” “CGRP Inhibitors for Migraine Prevention: What Prescribers Need to Know,” “Hormone Headaches and Menstrual Migraines: Management and Treatment.”

The Migraine Trust: “Migraine and the contraceptive pill,” “Supplements and herbs.”

American Family Physician: “Contraception Choices in Women with Underlying Medical Conditions.”

UpToDate: “Patient education: Migraine headaches in adults (Beyond the Basics),” “Sumatriptan: Drug information,” “Zolmitriptan: Drug information.”

American Headache Society: “Menstrual Migraine.”

Drug Safety: “Migraine in pregnancy: What are the safest treatment options?”

American Migraine Foundation: “Spotlight On: Migraine in Women.”

NIH Office of Dietary Supplements: “Acupuncture: In Depth,” “Riboflavin.”

National Center for Complementary and Integrative Health: “Headaches: In Depth.”

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