Understanding what makes women’s migraine unique can help doctors provide more specialized care

Shamin Masrour, DO

While migraine can affect people of any gender, age or background, it’s especially common in women. Three times more women live with migraine than men, and research has revealed that hormones play a role. During childhood, migraine prevalence is similar in boys and girls; after puberty, however, the frequency of migraine increases in girls. Girls are more likely to experience the onset of migraine at the time of their first menstrual cycle, and the prevalence of migraine in women peaks during their childbearing years. Women with migraine also experience more migraine-associated symptoms, such as nausea and vomiting, and women’s migraine attacks typically last longer than men’s. The fluctuation in hormone levels throughout a woman’s lifetime may influence the severity and frequency of headaches for those with migraine.

The connection between migraine and hormones

Many women report migraine headaches around the time of their menstrual cycle. Women with menstrual migraine and menstrual-related migraine develop headaches anywhere from two days before to three days after the start of menstruation. These attacks are usually more disabling than non-menstrual attacks. The connection is believed to be related to the hormone estrogen. When estrogen levels rapidly drop before menstruation, women have an increased likelihood to develop migraine headaches. The degree of fluctuation in the hormone, rather than the level itself, is thought to be the main instigator. During pregnancy, as estrogen levels rise and remain elevated throughout the pregnancy, migraine headaches improve for most women, and for some, they completely disappear. After pregnancy, however, the abrupt drop in estrogen levels may trigger headaches again.

During perimenopause, in the years leading up to menopause, migraine headaches may become more frequent and severe due to the uneven rise and fall of hormone levels during this period. Once women reach menopause, however, most experience improvement in their migraine headaches.

Treating hormonal migraine

Fortunately, there are ways to help reduce or prevent headaches in women whose migraine has a strong hormonal component. For women with predictable migraine headaches during their menses, the use of daily nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen or naproxen sodium, or triptans, such as frovatriptan—a few days prior to menstruation and through the duration of the menses may be beneficial. Some women find that using continuous hormonal contraception (ie skipping the placebo week) may prevent menstrually related migraine by preventing the inevitable drop in estrogen that occurs with the pill-free (placebo) week. Although hormonal contraception may help some women by minimizing the drop in estrogen associated with the menstrual cycle, it can make headaches worse in other women or have no effect at all. The use of hormone replace therapy during menopause may have similar effects. It is recommended that women with migraine headaches talk to their doctor before starting any hormonal therapy.