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Hormonal Headaches: Causes, Symptoms, Treatment, Prevention

What are Hormonal Headaches?

Many women tend to experience headaches that are caused by changes in their hormone levels. This type of headache is known as a hormonal headache or a menstrual migraine. Hormone levels change during a woman’s lifetime – be it during the menstrual cycle, pregnancy, or menopause. Hormone levels are also affected by hormone replacement therapies and even oral contraceptives. According to estimates by the National Migraine Center, over half of the women who suffer from migraines notice that it happens around or during their periods.(1, 2, 3) While hormonal headaches can be severe, there are several medications and other treatments available to relieve such headaches.

What are the Causes of Hormonal Headaches?

Headaches, especially migraines, are often associated with the female hormone estrogen. Estrogen is responsible for controlling those chemicals in the brain that affect your sensation of pain. If there is a fall in the estrogen levels in the body, it can cause a headache. There can be many reasons behind these changes in hormone levels. These include:

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  • Menstrual Cycle or Periods: The levels of the hormones estrogen and progesterone drop down to their lowest just before the start of menstruation.(4, 5, 6)
  • Pregnancy: Estrogen levels increase substantially during pregnancy. For many women, this is the reason why hormonal headaches disappear when they are pregnant. However, it is also possible that many women experience their first migraines at the start of their pregnancy, only finding relief after the first trimester finishes. After giving birth, though, estrogen levels go through a rapid decline.(7, 8)
  • Perimenopause and Menopause: The changing levels of hormones during the period of perimenopause, which are the years that lead up to menopause, can cause some women to experience more frequent and severe headaches. Around two-thirds of women who experience headaches at this time report an improvement in their symptoms after reaching menopause. However, for some, migraines can actually worsen, most likely due to the use of hormone replacement therapies after menopause.(9)
  • Hormone Replacement Therapy and Oral Contraceptives: Taking birth control pills and undergoing hormone replacement therapy cause the hormone levels to fluctuate. Women who have migraines due to hormonal changes will find that they experience more frequent headaches while on the pill, especially during the last week of their cycle. This happens because, during the last week of the menstrual cycle, the birth control pills do not contain hormones, causing the hormone levels to rise and fall.

There can be many other reasons as well for hormonal headaches. Genetics, for one, is believed to play a big role in chronic headaches and migraines. People who have migraines have been found to have a combination of factors that are more likely to cause headaches. Apart from hormones, some of the other contributing factors to headaches include:(10)

  • Not getting enough sleep or getting too much sleep
  • Intense sounds, smells, or lights
  • Severe weather changes
  • Skipping meals
  • Too much caffeine intake or going through caffeine withdrawal
  • Alcohol beverages like red wine
  • Having certain types of cheese
  • Consuming soy products
  • Consuming artificial sweeteners
  • Stress
  • Monosodium glutamate (MSG)
  • Processed meats, smoked fish, and hard sausages

What are the Symptoms of Hormonal Headaches?

The biggest symptom of a hormonal headache is, of course, a headache or migraine. However, many women experience many other symptoms that often help doctors diagnose a hormonal headache.

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Hormonal headaches or menstrual migraines are quite similar to a conventional migraine, and they may or may not be preceded by an aura. A migraine is best described as a throbbing pain that begins on one side of the head, and it may also include sensitivity to light and sound, along with nausea or vomiting.

Some other symptoms of hormonal headaches may include:

Can Hormonal Headaches be Treated?

There are a variety of treatments available for hormonal headaches. From home remedies to medications and even home therapy, there are many treatments for a hormonal headaches. Here’s a look at some of them.

  1. Home Remedies

    The thing to keep in mind with home remedies for treating hormonal headaches is that the earlier you start the treatment, the higher will be the chances of getting relief. Here are some home remedies that can help:

    • Lying down in a dark and quiet room.
    • Drink plenty of water and remain hydrated.
    • Massage the area where you feel pain.
    • Place an ice bag or cold compress on your head.
    • Take deep breaths or perform other relaxation exercises.

    Biofeedback can also help you understand how to relax specific muscles in the body to help reduce the frequency of your headaches or the intensity of pain. Sometimes doctors also recommend taking magnesium supplements, which also help reduce the intensity of your headaches. Lowering stress in your life can help prevent headaches and migraine attacks. Acupuncture and massage can also help relieve the pain.(11)

  2. Medication

    There are some medications that are focused on the acute treatment of such headaches. These medications have to be taken once the migraine attack or headache has begun. Some examples of these medications include:

    For women who experience hormonal headaches frequently, medications combined with preventive therapy should be used. These medications must be taken every day or before the time period in your menstrual cycle when you know the chances are highest of getting a hormonal headache. Such medications include:

  3. Hormonal Therapy

    In cases where preventive medications do not work, your doctor might prescribe hormone therapy. In this, you will be administered estrogen, which has to be taken daily through a patch or a pill. Birth control pills are most commonly used to balance out hormones and reduce the frequency of hormonal headaches. If you are already on some form of hormonal contraceptives and get hormonal headaches because of those, then your doctor is likely to alter your dosage. Depending on the issue, your doctor may also decide to switch you over to another medication that has a lower dose of estrogen to relieve your symptoms.

    For some women, doctors may recommend beginning the next pack of birth control pills early. This may mean skipping the hormone-free placebo pills that have to be taken in the last week of the pack. Doctors usually advise that you do this for at least three to six months at a time, thus helping reduce the frequency of your headaches.(16, 17)

    It is essential to keep in mind that if you are planning on conceiving or you think you might be pregnant or are currently breastfeeding, it is necessary to discuss all your medicines with the doctor. This is because certain headache medications can cause harm to the baby’s development, and your doctor will recommend alternatives.

    If you are on hormone replacement therapy medication and you experience a sudden increase in headaches, you should let your doctor know. Your doctor will adjust your dosage accordingly. Using an estrogen patch means the hormone will be delivered in a low and steady dose of estrogen, which helps reduce the frequency and severity of hormonal headaches.

Conclusion: Is It Possible To Prevent Hormonal Headaches?

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If your periods are regular, your doctor is likely to recommend taking some form of preventive medication for the headaches. This typically begins a couple of days before the onset of your periods and lasts up to two weeks. In some cases, you may need to be on daily medication. Maintaining a headache journal to keep track of your menstrual cycle, sleep, diet, and exercise can help identify the possible triggers of your headache.

If you take oral contraceptives, you can ask your doctor about switching to a pill with a lower estrogen dose, wearing an estrogen patch on the placebo days, switching to a progestin-only birth control pill, or taking low-dose estrogen pills on the placebo days.

And if you are not taking birth control pills, you can ask your doctor if taking them may help reduce these hormonal headaches.

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References:

  1. Anon, National Migraine Centre. Available at: https://www.nationalmigrainecentre.org.uk/ [Accessed August 30, 2022].
  2. Loder, E., Rizzoli, P. and Golub, J., 2007. Hormonal Management of Migraine Associated With Menses and the Menopause: A Clinical Review: CME. Headache: The Journal of Head and Face Pain, 47(2), pp.329-340.
  3. Edlow, A.G. and Bartz, D., 2010. Hormonal contraceptive options for women with headache: a review of the evidence. Reviews In Obstetrics And Gynecology, 3(2), p.55.
  4. MacGregor, E.A., 1997. Menstruation, sex hormones, and migraine. Neurologic clinics, 15(1), pp.125-141.
  5. Maybin, J.A. and Critchley, H.O., 2011. Progesterone: a pivotal hormone at menstruation. Annals of the New York Academy of Sciences, 1221(1), pp.88-97.
  6. Silverman, I. and Phillips, K., 1993. Effects of estrogen changes during the menstrual cycle on spatial performance. Ethology and Sociobiology, 14(4), pp.257-269.
  7. Marcus, D.A., 1995. Interrelationships of neurochemicals, estrogen, and recurring headache. Pain, 62(2), pp.129-139.
  8. Marcus, D.A., 2003. Headache in pregnancy. Current Pain and Headache Reports, 7(4), pp.288-296.
  9. Anon, Migraine. Migraine | Office on Women’s Health. Available at: https://www.womenshealth.gov/a-z-topics/migraine [Accessed August 30, 2022].
  10. Pakalnis, A. and Gladstein, J., 2010, June. Headaches and hormones. In Seminars in Pediatric Neurology (Vol. 17, No. 2, pp. 100-104). WB Saunders.
  11. Offers, C., Experts, A.O., Test, D., Dosha, V., Dosha, K. and Dosha, P., How to Get Relief From Headache-Effective Home Remedies & Tips.
  12. Tfelt-Hansen, P., De Vries, P. and Saxena, P.R., 2000. Triptans in migraine. Drugs, 60(6), pp.1259-1287.
  13. Macone, A.E. and Perloff, M.D., 2017. Triptans and migraine: advances in use, administration, formulation, and development. Expert opinion on pharmacotherapy, 18(4), pp.387-397.
  14. Pardutz, A. and Schoenen, J., 2010. NSAIDs in the acute treatment of migraine: a review of clinical and experimental data. Pharmaceuticals, 3(6), pp.1966-1987.
  15. Becker, W.J., 2015. Acute migraine treatment in adults. Headache: The Journal of Head and Face Pain, 55(6), pp.778-793.
  16. Bentivegna, E., Luciani, M., Scarso, F., Bruscia, C., Chiappino, D., Amore, E., Nalli, G. and Martelletti, P., 2021. Hormonal therapies in migraine management: current perspectives on patient selection and risk management. Expert Review of Neurotherapeutics, 21(12), pp.1347-1355.
  17. Calhoun, A.H. and Hutchinson, S., 2009. Hormonal therapies for menstrual migraine. Current pain and headache reports, 13(5), pp.381-385.
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