The Connection Between Headaches and Hormones

By: Pelin Batur, MD • Posted on January 02, 2019 • Updated March 09, 2021

Migraines in Women

Migraines in women are very common, affecting 40% of US women. Unfortunately, this is often misdiagnosed as tension or sinus headaches. In fact, 9 out of 10 patients who complain to their physician about chronic headaches have a diagnosis of migraine. Even those “sinus headaches” are usually migraines.

Symptoms of Migraines

Migraines can be throbbing or a constant pressure, located at various locations throughout the head and neck.
Nausea and vomiting may or may not accompany these headaches.
Although sensitivity to light or noise during the headache is suggestive of migraine, these symptoms are not required for the diagnosis to be made.

Menstrual Migraine

As if dealing with a monthly menstrual cycle is not enough of a hassle, a menstrual migraine (migraine headache associated with menses) is often the most severe and hardest to control for women. Typically, these headaches are triggered when estrogen levels drop immediately before menses, or sometimes after ovulation. This is also the reason why many women can have bad migraines immediately after delivering their child as there is a marked decrease in estrogen. Usually, migraines get better in pregnancy.

Hormones and Headaches

In the past, headache specialists were very nervous about the use of any types of hormones in their patients with migraines, for fear of stroke. However, the right type of hormonal contraceptive agent may completely eliminate these headaches. Those include the following:

Luckily, updated guideline recommendations from the American Headache Society, the Centers for Disease Control and the European Headache Federation all emphasize a tailored approach to the management of these headaches in each woman, as opposed to discouraging the use of estrogen-containing contraceptives in everyone.

Low dose birth-control pills used continuously (without a placebo break) control the ups and downs of hormones that work as a potent migraine trigger, especially during the perimenopausal time when headaches often worsen. Women with migraines can feel comfortable taking a birth control pill (or the vaginal ring) if they don’t get an aura, assuming they don’t have any other reason not to use estrogen containing agents.

Auras with Migraines

Auras are defined as visual or neurological changes which occur near the time of a migraine. There are specific criteria to diagnose an aura:

Auras typically last somewhere between 5 and 60 minutes.
Visual blurring, floaters or split-second flashes before or during a migraine headache do not meet the criteria for aura.

Those who have auras with their migraines need to discuss best treatment options with their women’s health specialist or headache specialist, given that auras can increase the risk of stroke.

Seeing someone who specializes in hormonal headaches can help women claim back their quality of life, especially during the menopause transition. Of note, using the wrong type of birth control pill (such as tricyclic or variable hormone levels) can actually make these headaches worse, instead of treating them. Luckily, for most women who have hormonal headaches, menopause is a time of great relief from migraines. Postmenopausal women who are suffering from bad menopausal symptoms can safely use hormone therapy even with a history of migraines, as long as there is no other contraindication.

Be Strong. Be Healthy. Be in Charge!

- Pelin Batur, MD
Women’s Health Specialist

Pelin Batur MD has been at the Cleveland Clinic since 1998. Dr. Batur graduated medical school from Northeastern Ohio Universities College of Medicine (NEOMED). After her internal medicine residency training, she completed specialty fellowship training in women’s health at the Cleveland Clinic. Her specialty interests include menopausal care, contraception, bone health, menstrual migraine, sexual concerns, as well as overall preventative women’s health. She has partnered with the Taussig Cancer Institute to develop a comprehensive Female Sexual Dysfunction program for cancer survivors.

women's health, dr. pelin batur, hormonal headaches, migraines in women, menstrual migraines, birth control pills

Columns