Women’s migraine patterns often have their roots in monthly, hormonal fluctuations, where changes in body chemistry cause imbalances that result in headaches. Many women find headaches are worse either during, before, or just after their periods as it is during this time that estrogen levels dip. Some schools of thought assert that it is not the level of estrogen in the body that causes the headache, but rather the change in the estrogen/progesterone balance. 

This theory may sound familiar, since those who suffer from weather-based migraine headaches also report changes in air pressure as one of their triggers. The barometric pressure doesn’t cause the headache; the change in pressure is responsible.  

Exactly why hormones and migraines are linked is not known, although some research indicates it could be because hormonal changes activate the parts of the brain that processes pain, plus the chemical changes cause the arteries in the brain to widen.  

Defining Hormonal Migraine 

At its strictest, menstrual or hormonal migraine is defined is one that starts up to 2 days before a period or around 3 days following the first day of bleeding. Also, because it is possible for migraines and periods to occur together coincidentally, it is generally a requirement that menstruation is always accompanied by a migraine attack in order for the headache to be described as hormonal. Hormonal headaches tend to fall into two general patterns: 

• Menstrual associated migraine: This occurs in women who have migraine attacks during their period, but also experience migraine episodes at other times too. This pattern affects roughly 6 out of every 10 women who suffer from migraine.
• Pure menstrual migraine: This pattern describes migraine attacks that occur only at the time of menstruation. This pattern is more rare, affecting around 1 in 7 women.  

Symptoms can change, either for better or worse, during pregnancy or when approaching or following the menopause. 

Diagnosing menstrual or hormonal migraine can be tricky, since other contributing factors need to be ruled out. Your doctor may ask you to keep a migraine diary (something every migraine sufferer should do anyway) for three months or more. Once you have this volume of information regarding when, where and how migraine episodes start and continue, menstrual migraine is more easily detected. 

Treatment Options for Hormonal Migraines  

Treatment for this type of migraine is much the same as treatment for any type of migraine. Options include anti-inflammatory painkillers, ordinary painkillers, triptan medication, and anti-sickness medicines. If menstrual migraine occurs frequently, it may be possible to take medication designed to prevent an attack, otherwise you may be prescribed medicine to take away the pain once it has started. 

Estrogen Top-Ups – Some women find taking estrogen supplements to keep levels topped up just before and during their period is helpful. Estrogen levels can be topped up via skin patches, which are applied around three days before the period is expected and worn for around a week. It’s similar to hormone replacement therapy, but only applied for one week during the month. Alternatives to patches include estrogen gel that’s rubbed into the skin for a similar length of time, and which travels through the body in the blood stream. Although this estrogen replacement therapy isn’t meant to treat hormonal migraine, it’s worth consulting your doctor if you think it would be personally helpful. 

Using Contraceptives – Useful for those who need contraceptives and who also get migraine, the pill (or a contraceptive patch) can help. With progesterone-based contraceptives, there is no drop in estrogen levels so migraines are not triggered. Using contraceptives to treat migraine can be a little complicated depending on whether you get migraine with or without aura. Your doctor will be able to advise. 

Using Natural Remedies – some people prefer to make lifestyle changes to see if this will help hormonal based migraines.  

• Changing your diet, such as by reducing your sugar intake, avoiding red wine, and eliminating gluten may help.
• Tyramine, the compound found in fermented foods like aged cheeses or cured, smoked meats is a common migraine trigger and some people find avoiding these helps reduce hormonal migraine.  

Dietary changes take some time to take effect so allow for at least 30 days.  

Stress can also influence hormonal imbalances so it is possible that meditation or yoga along with more exercise can help if you find you suffer from mood fluctuations during the month. 

As with other types of migraine headache and their triggers, there is no quick answer to suit every individual. If your migraines are worse, or only occur, during times of hormonal fluctuation, raise this issue with your doctor so he or she can help you decide on the best course of action.