Hormones and Headaches
What is the relationship between hormones and headaches?
It has been estimated that 70 percent of migraine sufferers are female. Of these female migraine sufferers, 60 to 70 percent report a menstrual relationship to their migraine attacks.
Headaches in women, particularly migraines, have been related to changes in the levels of female hormone estrogen during a woman’s menstrual cycle. Levels of estrogen drop immediately before the start of the menstrual flow (menses).
Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels.
Migraine attacks typically disappear during pregnancy. In one study, 64 percent of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. Less commonly, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy.
What triggers migraines in women?
Birth control pills, as well as hormone replacement therapy for menopause, can change the frequency or severity of headaches. If you notice your headache getting worse after starting one of these medications, it may be worthwhile to ask your physician for an agent that contains a lower dose of estrogen, request a change from an interrupted dosing regimen to a continuous one, or consider an alternative therapy that does not involve hormonal medications.
What are the treatment options for menstrual migraine?
The medications of choice in the treatment of menstrual migraine are non-steroidal anti-inflammatory medications (NSAIDs). The NSAIDS most often used for menstrual migraine include:
- Ketoprofen (Orudis)
- Ibuprofen (Advil and Motrin)
- Diclofenac (Cataflam, Voltaren)
- Naproxen (Naprosyn)
- Nabumetone (Relafen)
- Meclofenamate (Meclomen)
Therapy with the NSAID should be started two to three days before the onset of the menstrual flow and continued through the flow. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.
Other medications that have been prescribed perimenstrually for short term prevention of migraine include:
- Triptans such as sumatriptan
- Small doses of ergotamine (including Bellergal-S) or a similar compound, methylergonovine maleate (for example, Methergine)
- Beta blocker drugs such as propranolol
- Anticonvulsants such as valporate or topiramate
- Calcium channel blockers such as verapamil
- Tricyclic antidepressants such as amitriptyline
These drugs should also be started two to three days pre-menses and continued throughout the menstrual flow. This short term preventative therapy works best for women with predictable menstrual cycles and whose headaches are limited to the time of menstruation.
Because fluid retention is often associated with menses, diuretics have been used to prevent menstrual migraine but the benefit is limited to relieving the fluid retention and has little effect on the migraine pain. It may be better for the patient follow a salt-restricted diet immediately before the start of menses rather than using a diuretic.
For tough to treat menstrual migraines, hormonal manipulation may be recommended. Using an estrogen patch (such as estradiol) perimenstrually may prevent headaches by stabilizing the estrogen drop at menses. Lupron is another medication that affects hormone levels and is used only when all other treatment methods have been tried and have been unsuccessful.
What are the treatment options for menopausal migraine?
For patients who need to continue post-menopausal estrogen supplements, the patient should be started on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, the patient should take it on a daily basis. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may be effective in stabilizing the levels of estrogen.
For more information contact: Cleveland Clinic Neurological Center for Pain