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What To Do For Hormonal Migraines

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Oral Contraceptives May Reduce Menstrual Migraine Frequency

HORMONAL MIGRAINES! Why They Happen What To Do About Them

There is some evidence to suggest that certain types of oral contraceptive pills can actually reduce the frequency of menstrual migraine and menstrually related migraine, Hindiyeh says.

This doesnt apply to all kinds of oral contraception, so you should talk with your gynecologist, primary care doctor, or neurologist about which ones youd want to consider, says Hindiyeh. There are specific ones that will keep your estrogen level from fluctuating so much, she adds.

If youre considering taking oral contraceptives as a means of birth control or to try to improve your migraine symptoms, tell your healthcare provider about your migraine history, says Hindiyeh.

What If I Cant Take Estrogen

If you are overweight, weight loss can benefit both migraine and menopause symptoms.

Regular exercise has also been shown to be effective. Non-hormonal alternatives include escitalopram or venlafaxine. These drugs act on the chemical messenger serotonin, which is implicated in both migraine and hot flushes.

How To Prevent Menstrual Migraines

There is no cure for migraine, but there may be ways to reduce the number of episodes. Anyone with menstrual migraine should try to prevent sudden drops in estrogen levels. A persons options might include:

  • Switching birth control types: This might involve taking a different type of pill or opting for an implant, for example. It may be an especially good idea to switch to a continuous form of birth control one that does not involve a weekly break.
  • Trying estrogen gel or patches: A doctor may prescribe these for people with regular periods. A person applies the gel or patch before their period to prevent a drop in estrogen.
  • Using hormone replacement therapy: This is not a treatment for menstrual migraine it treats symptoms commonly associated with perimenopause or menopause. As an added benefit, a person might find that it relieves their menstrual migraine. However, for some people, it makes migraine episodes worse.

It is important to note that a person who has migraine with aura should not be taking birth control that contains estrogen. In general, anyone who experiences aura should let their doctor know.

Other migraine prevention strategies include:

It is important to be aware of the possible side effects and interactions of any drug or supplement and to consult a doctor before trying a new approach.

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Can You Prevent These Headaches

There are a few methods your doctor might suggest.

Hormonal:Birth control pills or estrogen patches and vaginal rings may help lower the number of menstrual migraines you have or make them less severe. But they donât work for everyone. In some cases, they could make your migraines worse.

Your doctor might tell you to stay on birth control for 3 to 6 months without taking any placebo pills. This will prevent you from having a period and may stop your headaches.

If you get migraines with auras, using birth control that contains estrogen and progesterone isnât a safe option. Taking it could make you more likely to have a stroke. Other reasons your doctor may not want you to take birth control for your menstrual migraines:

Medicines that prevent migraines: If you donât respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You can take these regularly to make the headaches less severe or less frequent. These could include:

Devices: Four devices may bring relief.

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What Can My Doctor Do To Help Me

5 Ways to Treat Hormonal Migraines Naturally

If diary cards confirm that your attacks always occur two or three days around the first day of your period, your doctor might consider ways to prevent migraine. They are less effective in women with additional attacks at other times of the cycle resulting from non-hormonal triggers.

Depending on the regularity of your menstrual cycle, whether or not you have painful or heavy periods, menopausal symptoms, or if you also need contraception, several different options can be tried. Although none of the drugs and hormones recommended below are licensed specifically for management of menstrual migraine, doctors can prescribe them for this condition if they feel that this would be of benefit to you.

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Prescription Treatment For Menstrual Migraines

If OTC medicines and natural remedies are not enough to control your menstrual migraines, a prescription treatment may be the best option for you. Furthermore, menstrual migraines can be more difficult to treat due to the effect of estrogen in your body. You may need a prescription on hand for when you get headaches around your period. Here are some commonly used prescription treatments.

  • Estrogen cream or patches: Remember how we said that a major cause of menstrual migraines is thought to be the drop in estrogen levels that happens during your period? Preventing such a quick and major drop in these hormones can help keep menstrual migraines away. For this, estrogen cream or patches can be used, starting a few days before your period.

While birth control pills can help prevent menstrual migraines, it can take some time for them to work. For more information on starting regular birth control, read our birth control pill guide.

Please note that this discount is solely from Cove and not related to The Pill Club or from engaging with The Pill Club website.

Menstrual Migraine Is Tough To Treat

Menstrual and menstrually related migraine can be the hardest kind of migraine to treat. can be pretty severe, they can last several days, and they can be quite debilitating, she says.

Even if you have migraine attacks only around the time of your period, for many women that may still mean five days or more a month, says Hindiyeh. In that case, its really time to talk to your doctor about daily preventive treatment options for migraine, she says.

Generally speaking, there are many treatment options for the prevention of migraine and menstrual migraine, says Hindiyeh. Heres a rundown of top medications and lifestyle modifications that can help reduce the frequency and severity of menstrual and menstrually related migraine attacks.

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Is Your Birth Control Causing Headaches

Headaches are sometimes a side effect of hormonal birth control . In one study, taking oral contraceptives affected migraines, with 24% of people experiencing increased frequency of migraines .

Estrogen-withdrawal headaches are a type of headache that people get during their âpill-freeâ or âsugar-pill weekâ when they are taking oral contraceptives. This type of headache usually goes away within 3 days, but then will return during the estrogen-free week of the next cycle .

Why Do Hormones Matter

Why Do Menstrual Or Hormonal Migraines Happen And What To Do About Them

Why do hormones matter? Well, clearly theres a difference between men and women. The incidence of migraine amongst women is much higher than in the male population. In the graph below, the red curve represents females and the blue curve represent males.

Overwhelmingly it seems to be the females driving the difference in migraine prevalence, particularly in their menstrual years. Hormonally migraines matter because they are: more frequent, longer lasting, more severe, more likely to relapse, and much harder to treat.

Image reference: Jensen R, Stovner L. Lancet

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Treating A Menstrual Migraine

Common migraine treatments, such as holding an ice pack to your head, practicing relaxation exercises, and taking OTC pain relievers such as a combination of acetaminophen, aspirin, and caffeine, can help relieve menstrual migraine symptoms. 2

If youre unsure about whether you are experiencing a migraine or if menstrual migraines are affecting your quality of life, you might benefit from a discussion with your doctor.


  • Headache Classification Subcommittee of the International Headache Society . The International Classification of Headache Disorders, 3rd Edition . Cephalalgia 2013 33 629¬-808.
  • Silberstein SD, Armellino JJ, Hoffman HD, Battikha JP, Hamelsky SW, Stewart WF, Lipton RB. Treatment of menstruation-associated migraine with the nonprescription combination of acetaminophen, aspirin, and caffeine: results from three randomized, placebo-controlled studies. Clin Ther. 1999 Mar 21:475-91.
  • Menstrual Cycle Headaches & Migraines

    Two types of headaches most commonly occur during our menstrual cycles: tension headaches and migraines. Tension headaches typically feel as if theres a pressure band wrapped around your head, or like a pulsing in your temples or behind your eyes, and women commonly experience them before their periods start but they may not have a uniquely hormonal cause and can be due to other common headache causes that occur coincidentally around your period, particularly if your period is a stressful time for you in general.

    Menstrual migraines have a well-established hormonal basis. If youre a migraine sufferer in general, unfortunately, youre more predisposed to having hormonally triggered ones, too. As many as 70 percent of women migraineurs experience a menstrual association. Dont you feel lucky! However, it is possible to only have menstrual migraines called pure menstrual migraines and not have them otherwise. Here are some the known or suspected links between our cycles and migraines.

    As Estrogen Drops, Serotonin Does, Too
    We Have a Lower Pain Threshold Before Our Periods
    Histamine Gets Into the Act
    It Can Happen Around Ovulation, Too

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    Which Treatment Option Is Best For You

    Keeping a diary of your headaches, including when they occur in relation to your menstrual cycle, as well as their severity and response to treatment, will help your doctor determine the presence of menstrual migraine. There are not any blood tests or any type of imaging that can be done to diagnose this, says Dr. David. Its purely done based on the history.

    A headache and menstrual diary can also help you and your doctor identify the best treatment for you. Women with menstrual migraine who have painful cramps may benefit more from a NSAID strategy with a triptan for rescue. Those who have predictable cycles and migraine attacks may benefit from a mini-prevention strategy. Those who dont have regular cycles can try other options.

    It is also important to discuss with your doctor any personal risk factors you may have for taking oral contraception, such as an increased risk of stroke, heart disease or blood clots, as hormonal birth control can affect women with migraine differently. Please let your provider know if you have migraine with aura when discussing hormonal options.

    The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.

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    How Can These Be Treated In The Long Term

    Hormonal Migraines

    Hormonal headaches can be greatly reduced by the regular administration of an estrogen therapy. It is advisable to talk to your doctor about your options, but these might be:

    • Estrogen supplements. There are a number of options for enhancing your estrogen levels, including natural ingredients such as soy and black cohosh.

    • Hormone replacement therapy . Designed for women going through menopause, HRT is available a different forms, such as gels and patches, and is used to reinstate hormonal balance.However, its side effects include an increase of blood clots and breast cancer.

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    Complementary Menstrual Migraine Treatments

    There are many different approaches to help manage menstrual migraine some involve medicinal treatments and others do not. Often it may involve a combination.

    Rest assure that it is possible to reduce and in some cases eliminate menstrual migraine. But it may involve working with a specialist and some trial and error.

    Complementary approaches for those with menstrual migraine include:

    • Dietary changes
    • Magnesium
    • Other natural therapies

    Most women with menstrual migraine have a healthy hormonal balance. However, if there is an imbalance of estrogen in relation to progesterone then a healthy diet is the first step . What we eat plays a huge role in our overall health and wellbeing.

    Nothing else affects our health more than what we eat.

    If you experience migraine attacks then your diet can be important.

    We hear all the time from the health community something like eat a varied and well-balanced diet to help prevent disease. Its been said so many times we can become numb to this important advice.

    To complicate things, some healthy foods may also act as triggers. Finding out which foods trigger attacks is not always easy.

    Prevention Of Hormonal Headache

    Prevention can include medications that reduce the likelihood of a migraine from occurring, as well as making lifestyle changes.

    According to the AMF, healthcare professionals may prescribe preventative medications that are off-label. In other words, they are not specifically designed to prevent migraine, but they may help.

    Common medications for prevention include:

    • Hormones: These come in various forms such as oral, gels, or patches that help prevent a drop in hormone levels leading up to menstruation.
    • NSAIDS: A person can take these approximately twice a day in the week leading up to menstruation.
    • Magnesium supplement: A person can start taking these on the 15th day of the cycle and continue until menstruation starts.
    • Triptans: A person can take these twice a day during menstruation. They may help prevent hormonal headaches from occurring.

    Another option is for a person to use continuous hormone therapy, often in the form of hormonal birth control. This approach may help regulate hormone levels and prevent headaches from occurring.

    Finally, a person can take steps to avoid other triggers that may contribute to their migraine. This can include:

    • eating a healthy diet and avoiding foods that may trigger an attack
    • regular exercise

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    How Do Sex Hormones Influence Migraine

    On the occasion of the Migraine Awareness Week 2019, weve invited Dr. Bianca Raffaelli Junior Fellow of the European Federation School of Advanced Studies to tell us about the influence of sex hormones on migraine and her current research project.

    Bianca Raffaelli2 Sep 2019

    Migraine affects women three times more often than men. This sex gap is most pronounced in the age group between 35 and 45 years, where migraine has a prevalence of 25-30% in females but only 8% in males. This results in approximately 500 million women worldwide who are severely impaired in their most productive years because they suffer from migraine. The huge associated health and social burden makes this topic highly relevant and has motivated me to do research in this field.

    Menstrual and menstrual-related migraine

    Hormonal changes during life stages and the regular menstrual cycle can affect the course of migraine. Read a detailed, systematic review on this topic in The Journal of Headache and Pain that I co-authored as a Junior Fellow of the European Headache Federation School of Advanced Studies .

    Somervilles Estrogen withdrawal hypothesis decreasing estrogen levels may trigger migraine attacks.

    Estrogen fluctuations cause migraine through complex genomic and non-genomic mechanisms. According to the Estrogen withdrawal hypothesis by Somerville , decreasing estrogen levels, for example before menstruation, may trigger migraine attacks.

    Exogenous hormones: cause or therapeutic option?

    How Is Menstrual Migraine Diagnosed

    What to Do For Menstrual Migraines

    There are no tests available for menstrual migraine. The most accurate way to tell if you have menstrual migraine is to keep a diary for at least three months recording both your migraine attacks and the days you menstruate.

    For menstrual migraine to be diagnosed migraine should occur predominately between two days before and up to three days into menstruation, in at least two out of three consecutive menstrual cycles.

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    Is It Common To Get Migraines Before Your Period

    I get migraines a few days before my period starts. Is it common to have migraines as part of PMS? Alaire*

    Yes. Lots of women who have migraines get them as part of their PMS symptoms. Doctors believe that changing hormone levels are to blame for this type of headache, which is known as a menstrual migraine.

    Take some steps to try to stop these headaches so you feel better. You could start by taking an over-the-counter medicine like ibuprofen to see if that works. If you often get headaches near your period, try taking the medicine for a few days around that time, even if your headaches havenât started yet. Doing this might help you avoid getting a headache. Getting enough sleep, not skipping meals, exercising regularly, and managing stress are other ways to help prevent headaches.

    If a headache does come on, sometimes a cool cloth or ice pack wrapped in a towel can help. You can also try lying down in a quiet, dark room.

    If these things donât work for you, or if your headaches are severe enough that you miss school or other activities, talk to your doctor. He or she may recommend a prescription medicine or refer you to a headache expert.

    *Names have been changed to protect user privacy.

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    Testosterone Its Not Just For Men

    Ive been on and off testosterone cream for many years. It gives me strength which I absolutely love.

    You might think this is just a male hormone but testosterone also helps with: mood, your energy levels, bone marrow production, fertility, and supports a healthy libido.

    As a cure for migraine headache, your testosterone levels need to be in balance to eliminate migraines.

    Measurement of testosterone levels is part of the male and female hormone panels that are used to identify the levels of other steroid hormones. The optimal range for men is 650-827 ng/dL for women, 60-76 ng/dL. .

    There are many forms of testosterone available: oral supplements, injections, cream, gel and transdermal patch.

    A word of caution though your body can convert DHEA to testosterone when its needed. So if you are also restoring your DHEA levels using supplementation already, get your doctor to help you monitor all of that.

    And P.S. making changes in your diet can effect hormones.

    This has been a general overview, but you can see that there are more hormones to balance than just your estrogens.

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