Migraine and hormones

For some women, hormone changes can trigger migraine. For example:

• at puberty
• during periods
• around the time of menopause
• with health conditions such as endometriosis.

More research is needed to better understand why this happens.

Hormonal migraine can be more intense and last longer than other types of migraine.

In Australia, about 70% of people with migraine are women. Migraine is an important women’s health issue as symptoms can impact many aspects of life, including work, relationships, social lives and health.

Menstrually-related migraine is when you get migraine attacks around the time of your periods, including at other times of your menstrual cycle.

Menstrual migraine is when you get attacks only before or during your periods. This type of migraine is less common.

If you have menstrually-related migraine, an attack usually happens from 2 days before your periods to 3 days after your periods starts. This is when oestrogen and progesterone hormone levels drop. Hormonal changes may be a key trigger.

If you have migraine attacks during this time for at least 2 out of 3 cycles, you are more likely to get a diagnosis of menstrually-related migraine.

It’s a good idea to keep a symptom diary for a few months and share this with your doctor.

Recent research suggests that hormone-like chemicals in the body called prostaglandins play an important role in female migraine.

Women with heavy or painful periods have higher levels of prostaglandins, which can create chronic pain and a higher sensitivity to pain.

If you have heavy or painful periods, you may be more likely to have menstrually-related migraine.

More research is needed to better understand the link between migraine and endometriosis.

We do know that:

• endometriosis can cause heavy and painful bleeding
• women with endometriosis are thought to produce more prostaglandins
• many women with endometriosis report having menstrual headaches
• many migraine patients report a history of heavy and painful periods
• starting periods early is a risk factor for migraine and endometriosis
• women with migraine are up to 5 times more likely to have severe endometriosis.

Everyone’s experience of menstrually-related migraine is different. You might need to try different treatments before you find one that works for you.

Your periods can change over time, for example, in the lead-up to menopause, so you may need to explore new treatments in the future.

Ask your doctor to recommend different ways to prevent menstrually-related migraine. For example:

• manage your migraine triggers well, especially around the time of your periods
• take prevention medicines in the days just before and during your periods
• take hormone medicines to even out the hormones that usually vary during your menstrual cycle, depending on the type of migraine you have
• take supplements, such as magnesium and vitamin B2
• try acupuncture to relieve symptoms.

When oestrogen hormone levels drop during your menstrual cycle, it can trigger migraine attack. This can also happen when you have irregular periods.

You may have irregular periods at different times in your life, including the lead-up to menopause.

Other health issues, such as PCOS and underactive thyroid, can also cause irregular periods.

When periods are irregular, it can be hard to predict and manage migraine attacks.

If you have migraine and symptoms of menopause, ask your doctor about using menopausal hormone therapy (MHT).

Everyone’s experience of MHT is different. It may improve or worsen your migraine symptoms, or you may not notice any changes.

When you see your doctor, they will ask about your medical history, your experience of migraine and other risk factors to work out the best MHT treatment.

Your doctor will recommend a treatment that keeps your hormone levels as steady as possible, to reduce the risk of migraine attacks.

Depending on your situation, they may recommend different types of MHT, including patches, pills or implants under the skin. They will also consider which doses may work best for you.

If you haven’t had a hysterectomy, you’ll need combined oestrogen and progesterone therapy to reduce the risk of endometrial cancer (cancer of the uterus).

An IUD with lower progestin (a synthetic type of progesterone) may be a good option if progestin triggers migraine attacks.

If you have hormonal migraine, don’t push through the pain. See your doctor and work on a treatment plan together.