The Migraine-Estrogen Connection

Why migraines increase when levels of this hormone change

Migraine affects over 39 million Americans, and women are affected more than men. This gender discrepancy in migraine prevalence is largely attributed to the natural fluctuation of the female hormone estrogen. Short-term declines, as well as erratic fluctuations in estrogen levels, can precipitate migraines in migraine-prone women.

Estrogen levels fluctuate throughout a woman's menstrual cycle. In particular, prolonged estrogen changes occur during pregnancy, breastfeeding, perimenopause, and menopause. Oral contraceptives and hormone replacement therapy (HRT) also influence estrogen levels in women who use these drugs.

The link between estrogen and migraines is complicated, but important to consider.

How Estrogen Levels Impact Migraines

The explanation for why drops and fluctuations in estrogen cause migraines is not completely clear, but there are several possible mechanisms.

Estrogen has a known impact on the action of serotonin, a neurotransmitter that modulates pain and mood. Estrogen also affects blood vessels and blood pressure, and blood vessel alterations are known to play a role in migraines as well.

It is likely that both of these factors, and possibly others, could mediate the estrogen-migraine connection.

Menstrual Migraines

Of the women who have migraine, between 20 to 60 percent report that they have them during menstruation. A menstrual migraine is defined as a migraine that occurs during the perimenstrual stage, which begins two days prior to the start of menstrual flow and ends around day three of a woman's period. During this window, estrogen levels drop.

Keep in mind that estrogen drops twice during a woman's menstrual cycle—once right after ovulation, which is mid-cycle (two weeks after your period) and again right before you start your period. Some women also experience migraines at mid-cycle, although mid-cycle migraines tend to be less severe and less prevalent than menstrual migraines.

There are several strategies you can use to treat or prevent your menstrual migraines.

Lifestyle Management

When you know that you are due for a menstrual migraine, be sure to get enough rest, don't skip meals, and maintain moderate caffeine intake. Avoid any of your migraine triggers and be prepared with an ice pack, tea, or whatever normally makes you feel better.

Medical Prevention

You may opt to work on preventing your menstrual migraines by taking medication a few days before you expect a migraine to begin. Taking an NSAID or the long-acting triptan Frova (frovatriptan) a couple days prior to your period may prevent a migraine from occurring in the first place, but be aware that this strategy doesn't always work. A migraine attack can start a few days later than it would have without preventative treatment.

Alternatively, to get to the root of the estrogen decline, some women take a prescription form of estrogen (for example, an estrogen skin patch or pill) during the week prior to menstruation. Sometimes, using an oral contraceptive regimen all month can help regulate estrogen levels.

Abortive Therapy

Abortive therapy describes medications used to end a migraine attack. Over-the-counter medications like acetaminophen or ibuprofen are often effective, but some migraineurs need stronger prescription medications, with triptans being among the most commonly prescribed for menstrual migraines.

Complementary and Alternative Therapy (CAM)

Magnesium supplements, taken at a dose of 400 to 500 mg per day may be helpful in preventing menstrual migraines. If you want to try this strategy, you should start taking daily magnesium about two weeks prior to the start of your period. Be sure to discuss this with your doctor first.

Progesterone declines along with estrogen right before your period, but it does not do so mid-cycle. While fluctuations in progesterone have an impact on migraines, this hormone does not impact migraines as powerfully as estrogen does.

Hormone Therapy Use

Many women use prescription hormonal therapy for treatment of medical conditions or for contraception. These medications contain estrogen, and they generally help reduce migraines, but that isn't always the case.

Birth Control Pills

Birth control pills can reduce the frequency and severity of menstrual migraines because they help stabilize estrogen levels. But for some women, oral contraceptives can actually trigger migraines.

Birth control pills generally contain estrogen and progesterone, and the ratio and dose of each hormone varies with different formulations. If you are using oral contraceptives for birth control, migraine prevention, or for both reasons, you and your doctor can observe your symptoms to see which formulation works best for you.

Having migraines with aura may increase the risk of oral contraceptive-associated strokes, so you and your doctor should discuss your overall health profile when considering their use.

Hormone Replacement Therapy (HRT)

HRT, which contains estrogen or a combination of estrogen and progesterone, is often used to help maintain hormone levels in women who have had a hysterectomy (removal of the uterus). HRT can also help regulate hormone levels to minimize symptoms of menopause and perimenopause.

HRT may help prevent migraines due to the consistent dosing, but this treatment can increase migraines as well.

Pregnancy and Breastfeeding

During pregnancy, you may experience a break from your migraines, especially during the second and third trimesters, when your estrogen levels are at their peak. In fact, up to 75 percent of women with a history of migraines note improvement over the course of their pregnancy. That said, about 8 percent report a worsening of their migraine attacks.

Most migraine treatments are not recommended during pregnancy. Compazine (prochlorperazine) and most anti-emetics (anti-nausea medications) are generally considered safe.

Generally speaking, migraine-prone women also experience a substantial decline in migraines throughout the weeks or months of breastfeeding, as estrogen levels tend to be stable. If you do experience migraines when you are lactating, be sure to discuss treatment with your doctor, as many medications can get into your breast milk and are not safe for your baby.

Migraine Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Perimenopause

Perimenopause is the period of time just prior to menopause when a woman's ovaries begin to slow down their estrogen-production. Estrogen levels decline, but not in a gradual manner. Instead, estrogen fluctuates sporadically, sometimes triggering clusters of migraines that can occur almost daily for weeks and are often interspersed with months of no headaches at all.

Some women find relief of migraines during perimenopause by taking hormone therapies that stabilize estrogen levels.

Menopause

Menopause is defined as the time when a woman stops having menstrual cycles for 12 months. This happens when a woman's ovaries have stopped producing estrogen. Migraines often get better after menopause, but in rare cases, they worsen.

Keep in mind that new headaches or migraines after menopause should be medically evaluated.

While you can develop chronic headaches at this stage in life, your doctor will want to make sure that you don't have another problem, such as a pinched nerve in the cervical spine, blood vessel disease, or a meningioma.

A Word From Verywell

Some women experience the effects of the estrogen migraine link on a monthly or almost bimonthly basis. Major life stages that involve estrogen changes, such as breastfeeding and menopause, can also alter migraine frequency and severity.

Interestingly, multiple studies have also found that women who have frequent migraines are less likely to develop certain types of breast cancer. Whether this is also related to estrogen levels is still unclear, but it suggests that the implications of the estrogen-migraine connection could involve other aspects of health as well.

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Article Sources

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