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Hormonal Headaches and Menstrual migraine: What type do you have?
Menstrual migraine are often a result of hormonal fluctuations
Top things to know:
More than 1 in 10 of Clue users tracked ‘headache’ in January 2024
About 1 in 5 women in the USA have reported migraine headaches, some of which may be menstrual migraine caused by oral contraceptives (birth control pills) and perimenopause (1,2,3)
Migraine headaches are more common in women than in men after puberty
Recommendations to manage your migraine include eating regularly, getting enough sleep, and introducing movement into your lifestyle (4)
The connection between headaches and hormones
Do you notice the same type of headache every month? Are you experiencing sensitivity to light, or pain on either side of your head? If so, it may be a hormonal headache. Hormonal migraine headaches are linked to the fluctuating levels of hormones throughout your menstrual cycle (2).
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Do I have a migraine or a tension headache?
The two types of hormonal headaches are:
Tension-type headaches (5)
Migraine (2)
Tension-type headaches are a common type of headache that are felt on both sides of the head and have a mild or moderate pressing or tightening quality (6). Some people experience worsening head pain around the time of their period (6). More research is needed about this type of headache pain and how it may be linked to the menstrual cycle.
Migraine is a debilitating headache disorder (6). Worldwide, 15% of the general population experience migraine (6). Migraine headaches are usually quite severe, often have a pulsating type quality, and are usually on one side of the head (6).
Migraine attacks can have additional side effects, including nausea, vomiting, and sensitivity to light or sound (6). These side effects can get worse by physical activity (6). Some people with migraine may experience aura symptoms, such as visual or sensory changes, which can occur before an attack, signaling that it is coming, or during an attack (6). A migraine headache can last up to three days (6).
How are my hormones connected to my headaches?
Hormonal headaches are sometimes called menstrual migraine. Up to 1 in 4 women and people with cycles who experience migraines also experience a link between their menstrual cycle and migraine (2). During the late luteal phase, your lower levels of the hormones progesterone and estrogen increase your chances of having a migraine by activating your internal opioid system (2). Some people may notice an increase in migraine activity for the first three days of their period (2). Others experience pain about two days before menstruation (7). More research needs to be done to understand if migraines are linked to other events of the menstrual cycle when estrogen levels fluctuate, like ovulation.
During childhood, migraine headaches happen in both boys and girls equally (2), but after puberty, migraine headaches are twice as common in women than men (2). Throughout a woman’s life, increased experiences of migraine can be linked to reproductive moments that coincide with changes in estrogen levels, like pregnancy and perimenopause (2).
How does estrogen affect headaches exactly?
When your estrogen level fluctuates or drops below a certain threshold, you may get a hormonal migraine (2). Estrogen directly influences several neurotransmitters in the migraine pain pathway that cause pain (2). When estrogen levels are high, glutamate, a neurotransmitter, becomes more active (2). In turn, this can cause an increase in migraine auras (2). A drop in estrogen levels along with a change in serotonin receptors, which estrogen helps regulate, could also trigger a migraine (2).
Estrogen may cause menstrual migraine by acting directly on the trigeminovascular system (2). The trigeminovascular system is the collection of nerves and blood vessels that make up the migraine pain pathway. Migraines are likely caused by a combination of neurological and vascular changes that generate a painful experience (2). Estrogen relaxes the smooth muscles of your blood vessels to dilate them, increasing blood flow to the brain and sensitizing the nerves that cause pain (2,7).
What can trigger hormone-related headaches?
Hormonal changes can affect people with migraine disorders.
You may notice a change in migraine around (2,5,7,8,9,10):
Pregnancy and birth
Hormone replacement therapy
Contraceptive pills
Surgeries, like a hysterectomy, cesarean-section delivery, or dilation and curettage
Your period
Perimenopause and menopause
Migraine patterns during pregnancy may vary from person to person (5). Some people notice fewer migraine headaches, while others notice an increase as their pregnancy progresses (5). Some people on hormone replacement therapy may see an increase in the number of migraine attacks with aura (8).
As mentioned, notable changes to the estrogen levels in your body can cause migraine. Those taking an estrogen-based contraceptive pill or hormonal replacement therapy may notice a change in migraine activity (2). One study found a slight association between migraine and having a hysterectomy, cesarean-section delivery, or dilation and curettage surgery (9).
Migraine headaches can have a genetic component; you’re more at risk for experiencing migraine headaches if someone in your family has them (7). Stress, anxiety, and depression are also associated with worsening migraine patterns (11).
How to manage and mitigate headaches and migraine
There are many ways to manage and mitigate headaches and migraine. Understanding when you experience headaches can provide you with more information. For example, whether your headaches are linked to your cycle. You can mitigate headaches by eating regularly and getting enough sleep, but there are also migraine-specific medications if your headaches are severe. Read on to find out more.
Tracking your headaches can empower you with knowledge about your body
Tracking your migraine with the Clue app can help your healthcare provider make diagnostic and treatment decisions (12). It can also help you understand what type of migraine you have. Clue can provide more information on symptoms, patterns, and triggers that may not be visible during an office visit with your healthcare provider (12). Tracking your migraine can help you understand the full impact your condition has on your daily activities, too (12).
What can I do for immediate migraine relief?
There are different methods you can use to manage your migraine pain.
Here are some ways to immediately relieve migraine symptoms (4):
Eating something
Drinking water
Drinking caffeine
Finding a dark, quiet space
Eating regularly: If you skipped a meal and have a migraine, try eating. Headaches are more common in general when meals have been skipped, especially breakfast (4).
Drink water: Similar to skipping meals, dehydration may be associated with headaches (4). If you notice head pain, consider drinking water (4). Limited research suggests it may help with headaches (4).
Drink caffeine: For some people, caffeine can help (4). For others, it may be harmful (4). When your cup of coffee has caffeine levels between 65 and 200 mg, it may actually act as a pain reliever (4). People who drink caffeine every day and suddenly stop may actually develop a headache due to withdrawal (4).
Find a dark and quiet space: For people experiencing a migraine attack, light and sound can make their migraine symptoms worse (7). Some people find relief by lying in dark, quiet rooms.
Natural lifestyle changes can also help hormonal headaches
Not all lifestyle changes are thoroughly studied, but these recommendations are fairly standard for how to help you cope with your headaches (4).
Try these natural lifestyle changes to mitigate migraine headaches (4):
Get enough sleep
Reduce stress
Exercise more
Get enough sleep: Poor sleep is linked to being a migraine trigger (4). Be sure to adjust your bedtime so that you wake up rested. If you commonly have headaches in the morning, get checked for sleep apnea (4).
Reduce your stress levels: Stress can trigger migraine (4). Relaxation techniques, mindfulness, and biofeedback could help (4). During biofeedback therapy, a therapist will monitor your heart rate and oxygen while conducting a therapy session (4). Mindfulness focuses on increasing your present awareness to reduce stress (4). Relaxation techniques can include breathwork, where you focus on deep breathing (4).
Exercise: A sedentary lifestyle and low levels of physical activity may be associated with migraine (4). Exercise may be difficult for some people if it triggers a migraine attack (4). If this is the case, you may need preventative therapy before starting to exercise (4). Any form of exercise is better than none (4).
Are there any alternative treatments for hormonal headaches?
Alternative treatments are always tricky to study, since they are hard to control and reproductive health is not as well-funded as pharmaceutical medicine. However, there is some research to suggest that these alternative treatments can help to mitigate migraines:
Magnesium supplements (13)
Acupuncture (14)
Magnesium: There’s some evidence that magnesium may help prevent menstrual migraine pain (13). This may be helpful for some people who prefer supplements over medication (13). Regular magnesium supplementation may shorten your attack and make them less painful (13).
Acupuncture: Acupuncture may offer some help in decreasing the frequency of tension headache occurrences when used at the start of symptoms (14), however more research is needed.
What medication can I take for migraine headaches?
You should consult with your healthcare provider before starting any new medications, and check the packaging for the active substances. Migraine medications include (1,8,15,16):
Triptans
Gepants
Monoclonal antibodies
Over-the-counter pain medication
Hormone stabilization techniques
Triptans (including sumatriptan): This medication treats active migraine pain (15). Take your triptan at the onset of pain for fast relief (15). One study found that up to three-quarters of people experienced headache relief two hours after taking their medication (15). You may need a prescription for this medication (15).
Calcitonin gene-related peptide (CGRP): Calcitonin gene-related peptide (CGRP) has been identified as a key player in migraine therapy, leading to new treatments in recent years. This type of medication can be used to treat current migraine or prevent future migraine (16). Some types of CGRP medications can provide long-lasting relief for about 30 days (17).
Over-the-counter pain medication like ibuprofen (NSAID) and acetaminophen (paracetamol): These therapies are only recommended for mild attacks (1). Consider asking your healthcare provider about triptans if you have moderate migraine or have more than nine pain days a month (1).
Hormone stabilization techniques: There is limited research supporting hormone replacement therapy and migraine reduction (8). If triptans, gepants, and CGRP monoclonal antibodies are not providing relief, hormonal replacement therapy may help (8). Low doses of estrogen may limit hormonal migraine (8).
Can the hormonal birth control pill treat my menstrual migraine?
Continuous oral contraceptives may be used when other methods of migraine treatment are ineffective (8). It may help reduce fluctuations in levels of estrogen (8). Talk to your healthcare provider about extended use of hormonal birth control, as this may not be the right therapy for everyone, especially those with migraine with aura (8).
Hormonal contraceptives that have a shorter hormone-free interval may provide the best relief from menstrual migraine (2). People who are receiving continuous estrogen hormone therapy may experience less painful, shorter migraine attacks that may improve with time (2).
People who use a transdermal patch during their “sugar pill” week may see the same type of relief (2). Contraceptive ring users may notice fewer menstrual migraines due to more stable hormone levels (2).
On the other hand, headaches are sometimes a side effect of hormonal birth control pills (8). People taking high doses of birth control pills may experience an increase in migraine with aura (8). Other people may notice more painful migraine with aura (8).
Do hormone headaches change across life stages?
Some people may notice a change in their migraine pattern throughout their lifetime (5). These changes may be more common during hormonal fluctuations, particularly estrogen (2). Typically, pregnancy, menopause, and perimenopause are life events that include fluctuations in estrogen (5,3).
Migraines and headaches during pregnancy and after birth
Migraine and tension headaches may account for most of the headaches experienced during pregnancy (5). Some people experience a noticeable reduction in their headaches during the second or third trimester of pregnancy (5). Some people may stop having headaches completely during this time (5). For about 10% of pregnant people, headache pain will worsen (5).
Over half of women with migraine will experience an attack within the first month after giving birth (18). This includes breastfeeding mothers (18). More research needs to be done to identify the risk factors associated with increased migraine during pregnancy.
After delivery, most people see their migraine return to their pre-pregnant pattern (5). Non-pharmacological treatment options are always recommended during pregnancy and breastfeeding, but paracetamol may also be used sparingly during the first and second trimesters (5). Always consult a healthcare provider to check whether your migraine medications and supplements are harmful to your fetus (5).
Some research links maternal migraine to low birth weight and preterm births (19), however, more research needs to be done to establish whether migraine or tension headaches cause harm to a developing fetus.
Migraines and headaches during perimenopause and menopause
Other reproductive stages in life can also impact when migraine attacks happen. During perimenopause, people are particularly vulnerable to migraine due to the fluctuations in estrogen that happen around that time (3). After menopause, migraine headaches may start to taper off to coincide with lower estrogen levels (10).
One study found that up to 24% of postmenopausal women experienced headaches, likely migraine (20). Research shows that you may be at risk of migraine during perimenopause if you experienced premenstrual syndrome (PMS), because you may be more sensitive to fluctuations in hormones (21).
When to seek help for menstrual migraine
You should schedule a visit with a healthcare provider if your headache or migraine is affecting your quality of life, like your work, sleep, or ability to concentrate (22).
Seek emergency medical attention if you experience a severe, sudden headache and (23):
Fever
Pain in your jaw when chewing
Weakness, numbness, or loss of vision
Loss of sensation
FAQs
What does a hormonal headache feel like?
There are two types of hormonal headaches. Hormonal migraine headaches are severe, pulsating headaches on one side of your head (6). Tension hormonal headaches are typically on both sides of the head and are usually mild to moderate (6).
How do you stop hormonal headaches?
Medications for hormonal headaches include NSAIDS, triptans, gepants, or some types of hormonal therapies (1,2). You can also try eating something, drinking water or caffeine, or finding a dark, quiet place (4). Lifestyle changes can include getting enough sleep, reducing stress, and exercising more (4). There are also alternative therapies that include magnesium supplements (13) and acupuncture (14).
What are the signs of low estrogen?
Migraine can be a sign of low levels of estrogen (2). Other signs could include vaginal dryness and painful sexual intercourse (24).
What are hormonal imbalance symptoms?
Hormonal fluctuations may cause changes in mood, changes in sex drive, night sweats, and poor sleep patterns (25), amongst many other symptoms.
