FACT: Women are twice as likely to have migraines, particularly during their menstrual time. According to a recent study in the journal Neurology, a woman is most susceptible two days before her period starts when migraine risk is increased by 71 percent.
There’s a wealth of evidence linking hormones to migraines ranging from clinical evidence like cited above, to real life stories of women who say they never had a migraine until they started taking the birth control pill, or stopped taking it, or become pregnant, or peri-menopausal. The onset of migraines with a significant change in a woman’s reproductive life is no coincidence. In fact, treatment of migraines in women may lie in the regulation of hormonal balance.
Like all the other symptoms of PMS, menstrual-related migraines are caused by the rise and fall estrogen during a woman’s monthly cycle. More specifically, the precipitous drop in estrogen during the second half of the menstrual cycle between ovulation and menstruation usually spells migraine for woman who are prone to menstrual migraines. True menstrual migraines occur exclusively during or right before bleeding begins. For reasons unknown to scientists, menstrual migraines are more severe than migraines that occur at other times of the month. Women who suffer from menstrual migraines will attest to their longer duration, increased nausea, bloating, cramping and greater difficultly in finding relief in pain medications.
Hormonal treatment seems like a logical treatment for migraines that are related to hormonal changes. However, the use of synthetic estrogen such as those in the birth control pill is still largely trial and error. Some women say the pill makes their migraines more frequent and severe, while other report an increase in pain when they cease using the hormones. If you’ve opted for the birth control pill as a method of stabilizing estrogen levels, be sure to keep a migraine journal and make your doctor aware of any changes in the frequency or severity of your migraines so that the dosage of estrogen can be adjusted.
As menopause approaches, women with menstrual migraines usually see an improvement in their monthly neural storms. In menopause, estrogen levels slowly drop off and, eventually, the monthly peaks and troughs cease. Some menopausal woman experience migraines for the first time due to falling estrogen levels. As with the birth control pill for menstrual migraines, it important be aware that migraine relief from hormone replacement therapy during menopause also varies greatly from woman to woman. Long-term use of hormone replacement therapy is also associated with serious health risk that need to be considered given that it can either improve or exacerbate migraine episodes.
• The Migraine Brain by Carolyn Berstein and Elain McArdle. Free Press, Toronto, 2008. Chapter 4, pages 68-77
• Migraine by Joan Raymond. Barnes& Noble Books, New York, 2003.