Migraines, headaches and hormones
It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report that their migraines are related to their menstrual cycles -- hence the name, menstrual migraines.
What is the relationship between hormones and headaches?
Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone oestrogen during a woman's menstrual cycle. Oestrogen levels drop immediately before the start of the menstrual flow.
Premenstrual migraines regularly occur during or after the time when the female hormones, oestrogen and progesterone, decrease to their lowest levels. It is thought that the fall in oestrogen levels, rather than low levels of oestrogen, is the trigger.
Migraine attacks typically disappear during pregnancy. In one study, 64% of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. However, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy.
What triggers hormonal migraines in women?
Oral contraceptives as well as hormone replacement therapy during menopause have been recognised as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking oral contraceptive pills, especially those containing high doses of oestrogen.
The frequency of side effects, such as headaches, decreased in those who took oral contraceptives containing lower doses of oestrogen and did not occur in those who took contraceptive pills containing progesterone.
What are the treatment options for menstrual migraines?
The over-the-counter medications that may help relieve menstrual migraine include:
To try and prevent menstrual migraine, non-steroidal anti-inflammatory drug (NSAID) treatment can be started two to three days before the menstrual period starts and continued until the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.
Other medications that may be used to prevent menstrual migraines include the prescription medications:
- Beta-blocker medications such as propranolol
- Anticonvulsants such as topiramate
- Antidepressants such as amitriptyline
- Serotonin agonists such as pizotifen and methysergide
Because fluid retention is often associated with a woman's period, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt intake immediately before the start of menses.
What are the treatment options for menopausal migraines?
For people who need to continue post-menopausal oestrogen supplements, the lowest dose of these agents should be used, on an uninterrupted basis. By maintaining a steady dose of oestrogen, the headaches may be prevented. An oestrogen patch may also be effective in stabilising the levels of oestrogen.
What are the treatment options for migraines during pregnancy?
During pregnancy, no treatment is recommended for migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy.
A mild pain reliever can be used, such as paracetamol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their doctor, midwife, obstetrician or headache specialist before taking anything.