Many women who suffer from migraines find that they are more likely to have a migraine just before or during their menstrual periods. These are called hormonal migraine headaches, because it is thought that the trigger of these headaches is related to fluctuating hormone levels. Not every migraine is a hormonal migraine, but there is a clear link between hormones and migraines.
Prior to puberty, migraines are much more common in boys than in girls. After puberty, however, this trend reverses, and by adulthood, migraines are three times more common in women than in men. Sex hormones are believed to play a significant role in this trend, but this is by no means the only factor influencing the incidence of migraines.
It is common for a woman to have her first migraine at or around the time of her first menstrual period. For some women, the frequency of hormonal migraines increases during puberty and early adulthood. Two patterns of hormonal migraines exist: one in which migraines occur only when associated with periods and one in which migraines also can occur at other times. In both cases, women often find that the frequency of hormonal migraines tapers off in the years before and during menopause.
A hormonal migraine is defined as one that occurs during the two days before a period or during the first two days of a period. The incidence of these migraines is related to the levels of the estrogen hormone, which is instrumental in controlling the menstrual cycle. In women who experience these migraines, the central nervous system reacts abnormally to the sharp fall in blood estrogen that occurs just before the onset of menstruation. The link between hormonal migraines and estrogen is the reason why migraine frequency tapers during menopause, because that is when estrogen levels naturally decrease and menstruation ceases. Women also tend to find that hormonal migraines cease during pregnancy, when estrogen levels remain high throughout.
In general, a hormonal migraine can be treated in the same way as any other migraine. Treatment options include over-the-counter anti-inflammatory medications and other pain medications, including migraine-specific painkillers. Prescription medications and anti-nausea medications might be necessary for women who experience nausea and very severe pain that does not respond to over-the-counter medication.
An alternative option is to use hormone replacement therapy just before and during a period. For example, using a topical estrogen gel or estrogen patches during the trigger days can help prevent hormonal migraines. This approach works because blood estrogen is maintained at the normal level, preventing the sudden drop that triggers a migraine.
Women who experience hormonal migraines might find that the frequency of migraines is influenced by oral contraceptives. Depending on the type of oral contraception used, hormonal migraines might become more or less severe or could even disappear altogether. In general, an estrogen-progesterone pill is more likely to influence migraine frequency than a progesterone-only pill is.