Migraines at the End of Menstruation and Low Iron

Woman suffering from migraine
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Menstrual migraines are common in female migraineurs, affecting up to one-half. They also tend to be more severe, last longer and are not as easily eased by migraine medications.

While the precise cause of these once a month migraine attack has never been fully understood, most experts agree that the decline in estrogen that occurs prior to menstruation plays a big role in this complex phenomenon.

That being said, now researchers suspect that iron deficiency anemia from the acute blood loss of menstruation may also play a role in migraine development, particularly in migraines.

Iron Deficiency Anemia

Iron deficiency anemia is the most common cause of anemia in the world and results from decreased red blood cell production in the body. Your red blood cells need iron to carry oxygen to tissues in your body. When iron stores in a person's body are deficient, there are less red blood cells made, and anemia results.

The four potentials ways in which iron deficiency anemia may develop in the body include:

  • Not enough iron intake (for example, a diet poor in iron-rich foods like red meat, spinach, and iron-fortified cereals and breads)
  • Increased iron demand in the body (for example, pregnancy)
  • Impaired iron absorption in the gut (for example, Celiac disease)
  • Loss of iron (for example, abnormal uterine bleeding)

Women who are in their childbearing years are at a particularly high risk of developing iron deficiency anemia due to regular menstruation, which causes blood loss.

A Link Between Iron Deficiency Anemia and Migraines

In a 2016 study in Headache, two neurologists observed a small number of female migraineurs who experienced migraines towards the end of menstruation (instead of the beginning, when estrogen levels decline). These migraines were labeled "end-menstrual migraines."

The doctors then checked ferritin levels in their patients during the time of their end-menstrual migraines. Ferritin is a protein that stores iron, and it's a simple blood test, which is why doctors use it to determine whether the body is low (or high) in iron. Of their 30 patients with end-menstrual migraines, 28 of them had ferritin levels less than 50ng/mL, with half of having ferritin levels less than 18ng/mL.

Of course, there is some variability about what a "normal" or even a "low" ferritin level is in the medical field. That being said, most would agree that ferritin levels above 100ng/ml rule out any possibility of an iron deficiency anemia and that levels less than 30ng/mL to 50ng/mL are consistent with a diagnosis of iron deficiency anemia.

With that, this study (albeit a small, observational study) is a good start in recognizing that iron deficiency may contribute to women's migraines during menstruation, especially those that occur towards the end of the cycle. Of course, it's important to remember that while a link may exist between iron deficiency anemia and migraines, it does not mean that acute blood loss is the direct cause of a woman's migraine attack. It may simply be a contributing factor in this complex neurological condition.

The real test will be to see if women with end-menstrual migraines have a reduction in their migraine once their iron stores are repleted—a study that will hopefully be done sometime soon.

One Step Further

It is also interesting to note that this link between iron deficiency anemia and menstrual migraines is not a new finding—although linking it to the end of menstruation migraines is.

Other studies have found a link between iron deficiency anemia and migraine attacks that occur during the perimenstrual period (two days prior to menstruating until three days into menstruating).

For example, in a 2015 study in Pain Medicine, iron deficiency anemia was found to be more common in women with a menstrual migraine than in their control group. The researchers of the study did not find that iron deficiency anemia was more common in women with tension-type headaches or in women who had migraines not associated with menses.

The researchers in the above study theorized that a combination of factors like estrogen depletion, iron deficiency, and dopamine dysfunction may lead to the development of menstrual migraines. Of course, it's likely different for each migrainuer—meaning estrogen depletion may be a trigger for one woman, iron deficiency for another, and a combination of the two for another woman.

This is why study examining iron supplements for treating menstrual migraines may be difficult. It could work for some women and not others.

A Word From Verywell

In the end, if you are someone who develops end-menstrual migraines, you may want to consider talking to your doctor about checking your ferritin levels. It may be worth a try to take iron if your levels are low.

Still, be sure to only take supplements under the guidance of your doctor. Some people should not take iron because of underlying health conditions. In addition, iron can cause stomach upset or constipation.

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