How Hormones Impact Migraine in Women
Dips in estrogen levels have been known to cause more frequent, intense migraine in women, which is a key sign of the link between migraine and hormones, particularly in women.
Women experience migraine more often than men after adolescence, although the disease is more common in boys before before puberty. The fluctuations in estrogen levels that women experience after adolescence may explain why women are 2 to 3 times more likely to experience migraine than men, said Dr. Katherine Hamilton, Headache Fellow at Montefiore Medical Center.
In a recent Facebook live chat hosted by the American Migraine Foundation, Hamilton discussed how dips in estrogen as women advance through different life stages can trigger migraine onset, and how women with migraine can be more proactive in their treatment.
Migraine caused by the hormonal fluctuations during the menstrual cycle is known as menstrual migraine. Many women experience migraine more frequently before, after or throughout the entirety of their menstrual cycle. Different treatment strategies may be more helpful depending on when migraine occurs in a patient’s cycle. Hamilton recommends patients experiencing menstrual migraine keep a headache diary so they can better identify patterns that can inform optimal treatment.
Patients who experience menstrual migraine without aura just before their cycle starts often find contraceptives ease their symptoms and reduce their migraine attacks. By skipping placebo pills and moving on to the next birth control pack, or taking low doses of estrogen on placebo days, some women are able to prevent the drop in estrogen that trigger their migraine. This treatment is not advised for women who experience migraine with aura, as the use of contraceptives can increase their risk of stroke.
Women with migraine who are pregnant, or are planning to become pregnant, will likely have to change their treatment plan, says Hamilton, as the majority of pharmacological migraine treatments are contraindicated for pregnant women and women who are breastfeeding.
Some women see no difference in their migraine during pregnancy, or may feel their migraine is worsening, but the vast majority of women report that they experience less frequent and less intense migraine attacks while pregnant.
Tell your doctor their plans for the future, and keep them updated on your family planning. With advance warning and open communication, you can get set up to explore their non-pharmacological treatment options (for example, bio-feedback or acupuncture) so that when the time comes, you feel ready to phase out their medications.
“A good rule of thumb is to stay in close communication,” said Hamilton.
Perimenopause is the time when a woman’s body is transitioning into menopause. This period can last up to ten years, and the accompanying hormone fluctuations have been known to aggravate migraine.
Patients experiencing perimenopause have a number of treatment options, unless they have experienced a cardiac event, which becomes increasingly common with age. Acute treatments like triptans or NSAIDs are not recommended for use in patients with heart disease. Preventative treatments, however, can be used for these patients. While answering questions from participants in the live chat, Hamilton recommended the use of Botox as a preventative for female patients in the perimenopausal period.
More commonly than not, “migraine in women tends to get better after menopause,” said Hamilton. “But there are some women this does not happen for, so it’s not a sure-fire guarantee.”
Knowledge is a powerful tool for migraine management, which it’s important to stay up to date on news and the latest research. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists. Visit AMF’s website to learn more and to find a headache doctor near you.