Estrogen levels fluctuate throughout a woman’s menstrual cycle. And prolonged estrogen changes occur during pregnancy, breastfeeding, perimenopause, and menopause. Oral contraceptives and hormone replacement therapy (HRT) also influence estrogen levels.
The link between hormones and headaches is complicated, but it’s important to consider whether this factor is having an impact on your migraines.
How Estrogen Levels Impact Migraines
The explanation for why drops and fluctuations in estrogen cause migraines is not completely clear, but there are several possible mechanisms.
Estrogen has a known impact on the action of serotonin, a neurotransmitter that modulates pain and mood. Estrogen also affects blood vessels and blood pressure, and blood vessel alterations are known to play a role in migraines as well.
It is likely that both of these factors, and possibly others, could mediate the estrogen-migraine connection.
Menstrual Migraines
Of the women who have migraine, between 20 to 60 percent report that they have them during menstruation. A menstrual migraine is defined as a migraine that occurs during the perimenstrual stage, which begins two days prior to the start of menstrual flow and ends around day three of a woman’s period. During this window, estrogen levels drop.
Estrogen drops twice during a woman’s menstrual cycle—once right after ovulation, which is mid-cycle (two weeks after your period), and again right before you start your period. Some women also experience migraines at mid-cycle, although mid-cycle migraines tend to be less severe and less prevalent than menstrual migraines.
There are several strategies you can use to treat or prevent your menstrual migraines.
Lifestyle Management
When you know that you are due for a menstrual migraine, be sure to get enough rest, don’t skip meals, and maintain moderate caffeine intake. Avoid any of your migraine triggers and be prepared with an ice pack, tea, or whatever normally makes you feel better.
Medical Prevention
You may opt to work on preventing your menstrual migraines by taking medication a few days before you expect a migraine to begin.
Taking an NSAID or the long-acting triptan Frova (frovatriptan) a couple days prior to your period may prevent a migraine from occurring in the first place, but be aware that this strategy doesn’t always work. It might decrease the severity or delay your migraine episode.
Alternatively, to get to the root of the estrogen decline, some women take a prescription form of estrogen (for example, an estrogen skin patch or pill) during the week prior to menstruation. Sometimes, using an oral contraceptive regimen all month can help regulate estrogen levels.
Abortive Therapy
Abortive therapy describes medications used to end a migraine attack. Over-the-counter medications like acetaminophen or ibuprofen are often effective, but some migraineurs need stronger prescription medications, with triptans being among the most commonly prescribed for menstrual migraines.
Complementary and Alternative Therapy (CAM)
Magnesium supplements, taken at a dose of 400 to 500 mg per day may be helpful in preventing menstrual migraines. If you want to try this strategy, you should start taking daily magnesium about two weeks prior to the start of your period. Be sure to discuss this with your healthcare provider first.
Hormone Therapy Use
Many women use prescription hormonal therapy for treatment of medical conditions or for contraception. These medications contain estrogen, and they generally help reduce migraines, but that isn’t always the case.
Birth Control Pills
Birth control pills can reduce the frequency and severity of menstrual migraines because they help stabilize estrogen levels. But for some women, oral contraceptives can actually trigger or worsen migraines.
Birth control pills generally contain estrogen and progesterone, and the ratio and dose of each hormone varies with different formulations. If you are using oral contraceptives for birth control, migraine prevention, or for both reasons, you and your healthcare provider can observe your symptoms to see which formulation works best for you.
Hormone Replacement Therapy (HRT)
HRT, which contains estrogen or a combination of estrogen and progesterone, is often used to help maintain hormone levels in women who have had a hysterectomy (removal of the uterus). HRT can also help regulate hormone levels to minimize symptoms of menopause and perimenopause.
HRT may help prevent migraines due to the consistent dosing, but this treatment can increase migraines as well.
Pregnancy and Breastfeeding
During pregnancy, you may experience a break from your migraines, especially during the second and third trimesters, when your estrogen levels are at their peak. In fact, up to 75 percent of women with a history of migraines note improvement over the course of their pregnancy. That said, about 8 percent report a worsening of their migraine attacks.
Most migraine treatments are not recommended during pregnancy. Compazine (prochlorperazine) and most anti-emetics (anti-nausea medications) are generally considered safe.
Generally speaking, migraine-prone women also experience a substantial decline in migraines throughout the weeks or months of breastfeeding, as estrogen levels tend to be stable. If you do experience migraines when you are lactating (breastfeeding), be sure to discuss treatment with your healthcare provider, as many medications can get into your breast milk and are not safe for your baby.
Perimenopause
Perimenopause is the period of time just prior to menopause when a woman’s ovaries begin to slow down their estrogen-production. Estrogen levels decline, but not in a gradual manner. Instead, estrogen fluctuates sporadically, sometimes triggering clusters of migraines that can occur almost daily for weeks and are often interspersed with months of no headaches at all.
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Some women find relief of migraines during perimenopause by taking hormone therapies that stabilize estrogen levels.
Menopause
Menopause is defined as the time when a woman stops having menstrual cycles for 12 months. This happens when a woman’s ovaries have stopped producing estrogen. Migraines often get better after menopause, but in rare cases, they worsen.
While you can develop chronic headaches at this stage in life, your healthcare provider will want to make sure that you don’t have another problem, such as a pinched nerve in the cervical spine or a blood vessel malformation.
A Word From Verywell
Some women experience the effects of the estrogen migraine link on a monthly or bimonthly basis. Major life stages that involve estrogen changes, such as breastfeeding and menopause, can also alter migraine frequency and severity.
Interestingly, multiple studies have also found that women who have frequent migraines are less likely to develop certain types of breast cancer. Whether this is also related to estrogen levels is still unclear, but it suggests that the implications of the estrogen-migraine connection could involve other aspects of health as well.
