Table of ContentsView AllTable of ContentsEstogen and MigrainesMenstrual MigrainesHormone Therapy UsePregnancy and NursingPerimenopauseMenopause
Table of ContentsView All
View All
Table of Contents
Estogen and Migraines
Menstrual Migraines
Hormone Therapy Use
Pregnancy and Nursing
Perimenopause
Menopause
Migraineaffects 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 hormone estrogen. Cyclical changes, as well as erratic fluctuations in estrogen levels, can precipitate migraines in migraine-prone women.
Estrogen levels fluctuate throughout the menstrual cycle. Prolonged estrogen changes occur during pregnancy, breastfeeding, perimenopause, and menopause. Oral contraceptives and hormone replacement therapy (HRT) also influence estrogen levels.
Thelink between hormones and headachesis complicated, but it’s important to consider whether this factor is having an impact on your migraines.
Relieving Hormonal Headaches: What Helps?
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.
Of the women who have migraine, between 20 to 60 percent report that they have them during menstruation.Amenstrual migraineis 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 person’s period. During this window, estrogen levels drop.
Estrogen drops twice during the menstrual cycle—once right after ovulation, which is mid-cycle (two weeks after your period), and again right before you start your period. Some people 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
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.It might decrease the severity or delay your migraine episode.
Alternatively, to get to the root of the estrogen decline, some people 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 likeacetaminophen or ibuprofenare 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 healthcare provider 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.
Many people 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 people, oral contraceptives can actually trigger or worsen 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 healthcare provider can observe your symptoms to see which formulation works best for you.
Havingmigraines with auramay increase the risk of oral contraceptive-associated strokes, so you and your healthcare provider 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 people having menopausal symptoms, whether from surgical menopause (ovaries being removed) or natural.
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 people 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.
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Perimenopause is the period of time just prior to menopause when the 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.
Menopauseis defined as the time when a person stops having menstrual cycles for 12 months. This happens when the 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 healthcare provider will want to make sure that you don’t have another problem, such as a pinched nerve in the cervical spine ora blood vessel malformation.
Summary
Some women experience the effects of the estrogen migraine link on a monthly or bimonthly basis. Major life stages that involve estrogen changes, such as breastfeeding and menopause, can also alter migraine frequency and severity.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Migraine Research Foundation.Migraine facts. 2019.Chai NC, Peterlin BL, Calhoun AH.Migraine and estrogen.Curr Opin Neurol. 2014;27(3):315-24. doi:10.1097/WCO.0000000000000091Aggarwal M, Puri V, Puri S.Serotonin and CGRP in migraine.Ann Neurosci. 2012;19(2):88-94. doi:10.5214/ans.0972.7531.12190210Macgregor EA.A review of frovatriptan for the treatment of menstrual migraine.Int J Womens Health. 2014;6:523-35. doi:10.2147/IJWH.S63444Kiesner J, Martin VT.Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms.Headache. 2013;53(6):935-46. doi:10.1111/head.12082Maasumi K, Tepper SJ, Kriegler JS.Menstrual migraine and treatment options: review.Headache. 2017;57(2):194-208. doi:10.1111/head.12978American Migraine Foundation.Resource library: magnesium. October 15, 2013.Calhoun AH, Batur P.Combined hormonal contraceptives and migraine: An update on the evidence.Cleve Clin J Med. 2017;84(8):631-638. doi:10.3949/ccjm..84a.16033Macgregor EA.Migraine, menopause and hormone replacement therapy.Post Reprod Health. 2018;24(1):11-18. doi:10.1177/2053369117731172Negro A, Delaruelle Z, Ivanova TA, et al.Headache and pregnancy: a systematic review.J Headache Pain. 2017;18(1):106. doi:10.1186/s10194-017-0816-0Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RBPerimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache.2016 Feb;56(2):292-305. doi:10.1111/head.12763Ripa P, Ornello R, Degan D, et al.Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-82. doi:10.2147/IJWH.S70073Additional ReadingWu X, Wang M, Li S, Zhang Y.Migraine and breast cancer risk: a meta-analysis of observational studies based on MOOSE compliant. Medicine (Baltimore). 2016 Jul;95(30):e4031. doi: 10.1097/MD.0000000000004031.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Migraine Research Foundation.Migraine facts. 2019.Chai NC, Peterlin BL, Calhoun AH.Migraine and estrogen.Curr Opin Neurol. 2014;27(3):315-24. doi:10.1097/WCO.0000000000000091Aggarwal M, Puri V, Puri S.Serotonin and CGRP in migraine.Ann Neurosci. 2012;19(2):88-94. doi:10.5214/ans.0972.7531.12190210Macgregor EA.A review of frovatriptan for the treatment of menstrual migraine.Int J Womens Health. 2014;6:523-35. doi:10.2147/IJWH.S63444Kiesner J, Martin VT.Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms.Headache. 2013;53(6):935-46. doi:10.1111/head.12082Maasumi K, Tepper SJ, Kriegler JS.Menstrual migraine and treatment options: review.Headache. 2017;57(2):194-208. doi:10.1111/head.12978American Migraine Foundation.Resource library: magnesium. October 15, 2013.Calhoun AH, Batur P.Combined hormonal contraceptives and migraine: An update on the evidence.Cleve Clin J Med. 2017;84(8):631-638. doi:10.3949/ccjm..84a.16033Macgregor EA.Migraine, menopause and hormone replacement therapy.Post Reprod Health. 2018;24(1):11-18. doi:10.1177/2053369117731172Negro A, Delaruelle Z, Ivanova TA, et al.Headache and pregnancy: a systematic review.J Headache Pain. 2017;18(1):106. doi:10.1186/s10194-017-0816-0Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RBPerimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache.2016 Feb;56(2):292-305. doi:10.1111/head.12763Ripa P, Ornello R, Degan D, et al.Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-82. doi:10.2147/IJWH.S70073Additional ReadingWu X, Wang M, Li S, Zhang Y.Migraine and breast cancer risk: a meta-analysis of observational studies based on MOOSE compliant. Medicine (Baltimore). 2016 Jul;95(30):e4031. doi: 10.1097/MD.0000000000004031.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Migraine Research Foundation.Migraine facts. 2019.Chai NC, Peterlin BL, Calhoun AH.Migraine and estrogen.Curr Opin Neurol. 2014;27(3):315-24. doi:10.1097/WCO.0000000000000091Aggarwal M, Puri V, Puri S.Serotonin and CGRP in migraine.Ann Neurosci. 2012;19(2):88-94. doi:10.5214/ans.0972.7531.12190210Macgregor EA.A review of frovatriptan for the treatment of menstrual migraine.Int J Womens Health. 2014;6:523-35. doi:10.2147/IJWH.S63444Kiesner J, Martin VT.Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms.Headache. 2013;53(6):935-46. doi:10.1111/head.12082Maasumi K, Tepper SJ, Kriegler JS.Menstrual migraine and treatment options: review.Headache. 2017;57(2):194-208. doi:10.1111/head.12978American Migraine Foundation.Resource library: magnesium. October 15, 2013.Calhoun AH, Batur P.Combined hormonal contraceptives and migraine: An update on the evidence.Cleve Clin J Med. 2017;84(8):631-638. doi:10.3949/ccjm..84a.16033Macgregor EA.Migraine, menopause and hormone replacement therapy.Post Reprod Health. 2018;24(1):11-18. doi:10.1177/2053369117731172Negro A, Delaruelle Z, Ivanova TA, et al.Headache and pregnancy: a systematic review.J Headache Pain. 2017;18(1):106. doi:10.1186/s10194-017-0816-0Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RBPerimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache.2016 Feb;56(2):292-305. doi:10.1111/head.12763Ripa P, Ornello R, Degan D, et al.Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-82. doi:10.2147/IJWH.S70073
Migraine Research Foundation.Migraine facts. 2019.
Chai NC, Peterlin BL, Calhoun AH.Migraine and estrogen.Curr Opin Neurol. 2014;27(3):315-24. doi:10.1097/WCO.0000000000000091
Aggarwal M, Puri V, Puri S.Serotonin and CGRP in migraine.Ann Neurosci. 2012;19(2):88-94. doi:10.5214/ans.0972.7531.12190210
Macgregor EA.A review of frovatriptan for the treatment of menstrual migraine.Int J Womens Health. 2014;6:523-35. doi:10.2147/IJWH.S63444
Kiesner J, Martin VT.Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms.Headache. 2013;53(6):935-46. doi:10.1111/head.12082
Maasumi K, Tepper SJ, Kriegler JS.Menstrual migraine and treatment options: review.Headache. 2017;57(2):194-208. doi:10.1111/head.12978
American Migraine Foundation.Resource library: magnesium. October 15, 2013.
Calhoun AH, Batur P.Combined hormonal contraceptives and migraine: An update on the evidence.Cleve Clin J Med. 2017;84(8):631-638. doi:10.3949/ccjm..84a.16033
Macgregor EA.Migraine, menopause and hormone replacement therapy.Post Reprod Health. 2018;24(1):11-18. doi:10.1177/2053369117731172
Negro A, Delaruelle Z, Ivanova TA, et al.Headache and pregnancy: a systematic review.J Headache Pain. 2017;18(1):106. doi:10.1186/s10194-017-0816-0
Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RBPerimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache.2016 Feb;56(2):292-305. doi:10.1111/head.12763
Ripa P, Ornello R, Degan D, et al.Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-82. doi:10.2147/IJWH.S70073
Wu X, Wang M, Li S, Zhang Y.Migraine and breast cancer risk: a meta-analysis of observational studies based on MOOSE compliant. Medicine (Baltimore). 2016 Jul;95(30):e4031. doi: 10.1097/MD.0000000000004031.
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