Provided by Dr. John Collins, Comprehensive Neurology Services
For women, being hormonal can be a headache, but can your female hormones affect your migraine headache? Unfortunately, the answer is yes if you suffer from migraines.
Prior to puberty, headache occurrence is about equal in males and females. After puberty, there is a dramatic shift towards females with three out of every four migraine headache patients being female. This is believed to a consequence of an increase in estrogen.
Estrogen plays a central role in regulation of the menstrual cycle and pregnancy. It also influences chemicals in the brain that affects a woman’s pain perception and can trigger increased migraine headaches. Fluctuating estrogen levels can adversely influence headache patterns. This means the menstrual cycle, oral contraceptives, pregnancy, menopause, and hormone replacement therapy (HRT) can all influence migraine attacks.
More than half of migraine headaches in women typically occur around the menstrual cycle. Estrogen levels drop significantly just before menstrual flow. Menstrual migraines, which can affect up to 60 percent of females with migraines, occur during the peri-menstrual period (two days before and three days during menstruation). These headaches are typically more severe than regular migraines.
Oral contraceptives have been known to trigger the first migraine attack, especially in women with a family history of migraines. Of particular concern with oral contraceptives is the risk of stroke in the migraine sufferer. Research has shown there is a much higher risk of stroke compared to non-migraine females with oral contraceptive use. This is even higher for women who have complex migraines, migraines associated with neurologic deficits. Caution is recommended in the use of oral contraceptives with physician assessment of stroke risk. They can be beneficial for migraine treatment in the appropriate setting by helping to reduce estrogen fluctuations.
With pregnancy, there is a rapid rise in estrogen levels in first trimester followed by gradual increase in estrogen level for the remainder of the pregnancy. This produces tendency towards reduction in migraines during the second and third trimesters of pregnancy. Immediately after delivery, more than 50 percent of migraine sufferers experience headache return since there is a drop in estrogen levels.
After menopause, migraine sufferers typically experience reduction in their headaches. Unfortunately, menopause is associated with increased exacerbation of headaches due, once again, to estrogen fluctuations. Hormone replacement therapy can be used during this period to help stabilize estrogen levels. However, this should be done with consideration of possible complications. Consideration of the hormone replacement therapy should always be discussed with your healthcare provider.
It is important to note that hormones, in particular estrogen, are only part of our understanding of migraines in women. Migraines are neurological disorders of the central nervous system involving complex interactions involving brain chemistry and anatomy that result in a headache pain syndrome that can be managed in most cases. It can manifest in a number of ways with a variety of symptoms and predisposing factors. Careful medical evaluation is always recommended since it can mimic other types of headaches that have greater implications.