Hormonal Headaches are the Second Most Common Menopause Symptom – Second to Hot Flushes.

Migraines and headaches are more often experienced by women than men. In a study looking at menopausal women and the extent, severity and types of symptoms experienced, 57% of the study group experienced headaches, second only to menopause hot flushes, which are experienced at about 61%.

Prior to puberty, a survey found that both boys and girls have an equal occurrence of 4% in developing migraines/headaches. On commencement of puberty, the lifestyle occurrence of migraines in girls increased to 18% and 6% for men. This statistic suggests a hormonal link between females and migraines.

Menstrual Migraines

Quite often, for most women who experience headaches during their menstrual and perimenopausal years, headaches/migraines are most likely to occur 2-3 days prior to the commencement of the period and may follow for an additional 3 days. These types of headaches are quite often called, menstrual migraines.

Many population studies have found improvements in migraines after menopause, with an increase noted in perimenopause.

The exact cause of menstrual migraines are not entirely known however, it is theorised and substantiated by some studies, that it is contributed by a decline in oestrogen levels, known as oestrogen withdrawal. The first time this was investigated was over 40 years ago when the oestrogen withdrawal hypothesis was developed.

Oestrogen Withdrawal Hypothesis

According to this hypothesis, migraines/headaches are triggered by a sudden drop in oestrogen levels immediately before a period commences and during the transition towards menopause. The possible reason for more frequent headaches during perimenopause, can be related to the drastic fluctuations in oestrogen and progesterone, that occurs, which is usually greater than those occurring during the normal phases of the menstrual cycle in the reproductive years.

When looking at the roles of the main sex hormones, oestrogen and progesterone, oestrogen stimulates the nervous system and progesterone does the opposite. As a result, imbalances between these hormones, which most likely occur during the commencement of puberty and during perimenopause, contribute to the increased susceptibility of headaches and migraines in these age groups.

Oestrogen Build Up Headaches

Although oestrogen withdrawal tends to be the most plausible contributing factor to hormonal headaches, in some women, oestrogen build up headaches can’t be overlooked either.

Oestrogen build up tends to occur during mid cycle, approximately day 14 of a 28 day cycle. This oestrogen climb continues all the way through the cycle, until the end of the cycle where it reduces, with progesterone, to allow for a bleed to occur.

In perimenopause, when ovulation eventually stops, progesterone becomes deficient however, oestrogen levels still fluctuate and remain high. As a result of this, oestrogen becomes unopposed, meaning there is an imbalance between progesterone and oestrogen and the oestrogen build up headache/migraine can be experienced more regularly.

In this situation, it can sometimes be difficult to determine whether the headache/migraine is related to actual oestrogen itself or, the inability of the body to produce progesterone, hence, related to a progesterone deficiency.

The way to determine the difference, is for a symptom diary to be kept determining what other symptoms are associated with the headaches/migraine. For example, oestrogen build up can contribute to the following symptoms:

• Moods swings
• Irritability
• Fluid retention
• Weight gain
• Increased appetite and sugar cravings

What Can Be Done to Prevent Hormonal Headaches?

As hormonal headaches have a definitive cause, strategies to prevent them, tend to be associated with symptom management, rather than treating the cause, unless hormones are actually taken. Certain lifestyle and dietary changes can be implemented to prevent the severity of these hormonal headaches/migraines. These may include:

• Reducing/eliminating foods that are known to trigger headaches/migraines in the individual such as, cheese, caffeine, alcohol (wine), chocolate and dairy.
• Maintaining hydration.
• Reduce muscular tension to reduce stress and prevent restrictions to circulation.
• In some people, NSAIDs, such as Nurofen, may need to be taken in the lead up to the hormonal changes, to prevent the headache from occurring.

Treatment of Hormonal Headaches

At the Australian Menopause Centre, we prefer to treat the cause of menstrual and hormonal symptoms. The 1^st step is to identify which hormone is contributing to the headaches. Quite often, it can take a good 3 months to reduce the severity and frequency of hormonal headaches. Whilst the most suitable treatment maybe a bio-identical hormone, other complementary therapies can be utilised, in conjunction with bioidentical hormones, to further improve treatment outcomes. These may include:

• Acupuncture, which has been shown, through multiple studies, to reduce the severity and frequency of migraines/headaches.
• Massage, to relieve muscular tension which, quite often, can worsen the intensity of headaches/migraines.
• Magnesium, B2 and CoQ10 which in a combination, patented formula, has been proven to reduce migraine frequency. When looking into such products, it is best to speak to AMC’s Naturopathic team to see what will be suitable for you.

If hormonal headaches are a concern for you, it is recommended to speak to our team to determine the best treatment approach.

References:

• Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular disease. J Headache Pain. 2012: 13(3) 177-89
• Gaul C, Diener H, Danesch U. Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double blind, multicenter trial. J Headache Pain. 2015:15 32.
• Ripa P et al. Migraine in menopausal women: a systematic review. Int J Women’s Health. 2015: 7 773-82
• Pavlovic J et al. Sex hormones in women with and without migraine. Evidence of migraine specific hormone profiles. American Academy of Neurology. 2016 87.
• Inayat K, Danish N, Hassan L. Symptoms of Menopause in Peri and Postmenopausal women and their attitude towards them. J Ayub Med Coll Abbotabad 2017; 29(3) 477-80
• Lipton R, Steward W, Diamond S, Diamond M, Reed M. Prevalence and burden of migraines in the United States: data from the American Migraine Study II. Headache 2001. 41(7) 646-57