Menstrual migraines create a “diagnostic dilemma” for clinicians, which means we are often underestimating the importance of female hormones in migraine sufferers. Women with menstrual migraines may also suffer from regular headaches or less intense migraines in their non-menstrual weeks and women with regular migraines may happen to suffer from a migraine in their pre-menstrual week even though it is not being triggered by her hormones.
Menstrual migraines are linked to hormonal changes, and many sufferers aren’t aware of the impact of their cycle on their headache. Often women can identify that their migraines are more frequent during their PMS or menstrual phases of their cycle or more intense than the rest of their migraines during the month but rarely do women understand the impact that their hormones are having on their migraines.
Towards the end of your menstrual cycle, the hormones estrogen and progesterone start to decline to their lowest levels throughout the entire month. For some women this low level of oestrogen becomes a trigger for migraines.
During the last few days of the menstrual cycle both estrogen and progesterone levels plummet to restart the next cycle. Both estrogen and progesterone influence brain chemistry, and for women who are susceptible to migraines, this fluctuation may be enough to trigger a headache. Estrogen causes fluctuations in magnesium levels, neurotransmitter levels (serotonin) and inflammatory chemicals called prostaglandins, all of which are triggers for headaches. Further connecting estrogen to migraines we see a reduction in migraines and women who use continuous oral contraceptives, who are treated with estrogen. With more consistent levels of estrogen, these women don’t have the hormonal drop at the end of the month and avoid this migraine trigger.
Menstrual migraines don’t necessarily mean that women don’t have headaches throughout the rest of the month. It often means that the headaches that women experience during that pre-menstrual phase of their cycle are more intense than the rest of the month and the hardest to treat.
It is important for women to have their menstrual migraines assessed and treated. Women who experience premenstrual migraines often experience of worsening of their headaches through perimenopause and menopause. These times of a woman’s life are often met with a lower than normal levels of estrogen, which triggers an increase in intensity and frequency of headaches. These types of migraines typically start the day or two before the menstrual cycle and then resolve themselves around day four or five of the following cycle. This migraine-window may be extended in women over the age of 45 given the low levels of hormones they experience throughout the month.
Estrogen has been used as a treatment for chronic migraines related to the menstrual cycle, with women often finding benefit by increasing the number of days per month that they take their oral contraceptive pill or by using low dose estrogen (patch or cream) during the low estrogen days of the month. Estrogen cream or the estrogen patch can be used to support women in as little as 5-10 days per month to reduce the frequency and severity of menstrual migraines and can reduce the number of days women require medication for their migraines, or the lost quality of life that women experience with their headaches.
Women who have low estrogen headaches may also have other symptoms related to low estrogen such as hot flashes, vaginal dryness or mood changes. These symptoms may also show up in the same window of time as migraines, but may also be experienced in other times of the month, especially if women are over 45 years of age.
If you were suspicious that your migraines are hormonal, are you sure to track your headache frequency and intensity against your menstrual cycle. This can help your practitioner design a treatment plan that takes into account not only the severity of your symptoms but also the root cause. All of the naturopathic doctors at our office have a prescribing license in Ontario for hormone replacement therapy, which includes the treatment of migraines with estrogen.