What is the Relationship between Hormones and Migraine?

#WomenAndMigraine
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May 31, 2022
May 14, 2021
3
minutes
What is the Relationship between Hormones and Migraine?

How do hormones affect migraine?

Migraine and hormones are very closely intertwined, but their connection is often misunderstood.  Many people begin to experience migraines around puberty, and one of the more common migraine triggers is the hormonal fluctuations around the menstrual period. But migraines don’t happen because of your period, and many other hormonal issues can also trigger migraine attacks.  Let’s take a closer look at how this works. 

How do triggers cause migraine in the first place?

If you have migraines, it’s because of genetics: if you have the genes for migraine, you can experience migraines, and if not - thankfully, you just can’t.  But that doesn’t mean that if you do experience migraines, they will occur constantly. Certain things will trigger attacks, and those triggers are very unique to each individual.  Most triggers are related to a change - they can be external to the person experiencing the migraine, like the weather, or they can be internal, like something changing in the person's body.  So when the levels of certain hormones change, you’re more likely to get a migraine. 

Epidemiological studies have looked at who experiences migraine at different ages, and they found an interesting pattern.  Children before puberty experience migraine at a 50:50 ratio of boys to girls, but at reproductive age the ratio is 3:1 female to male, and among adults 65 and older it’s actually slightly more prevalent among men.  The reason behind this pattern is thought primarily related to the additional trigger of hormonal fluctuations around women's menstrual periods

Are there specific treatments for menstrual migraine?

If you experience migraine solely around your period, your doctor might consider a “bridge” or short term preventive - something to take just around your period.  This might be a long acting anti-inflammatory or triptan medication, just for the day prior to your period starting through the first few days of your period.  This might spare you the days of headache, and allow you to not have to commit to being on a longer-term daily medication.  

If you don’t experience aura with your migraine, and you are currently on a birth control pill, your doctor might recommend a low dose estrogen or progesterone-only pill that might help decrease the spikes of estrogen fluctuating throughout the month. Some longer-term birth control courses (over 3 months at a time) might also help with decreasing the number of periods you have, as can an IUD.  Your headache specialist and OBGYN may need to discuss this treatment together.  

Hormones and Aura

Having migraine slightly increases the risk for some vascular issues, like heart attack, stroke and blood clots.  This increase is very minimal, but having auras with your migraine (visual or other symptoms that precede the pain) is a more significant risk factor.  Estrogen is a pro-thrombotic hormone, it can make the blood more likely to clot.  For this reason, most estrogen-containing birth control pills are not recommended if you have migraine with aura.  Definitely discuss this with your OBGYN when you are reviewing birth control options. 

Other Hormones

Estrogen is not the only hormone that triggers migraine.  Abnormalities with thyroid hormones can sometimes present first with worsening migraine.  Stress, the most common trigger for migraine is associated with changes in cortisol levels and adrenaline.  It’s always important to consider a broad range of issues when you notice your migraines worsening without a clear explanation, and your doctor might want to consider a panel of blood tests to evaluate for many of these causes.  

The most challenging part of balancing your hormones and migraine is constantly changing levels. If you experience migraine during your menstrual period, Neura Health can help you get the right treatment according to your personal needs. Join us today!

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Thomas Berk, MD
Thomas Berk is Medical Director at Neura Health and a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is an emerging leader of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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