Headaches can be caused by many factors, including genetics and dietary triggers. In women, fluctuating hormone levels are a major contributing factor in chronic headaches and menstrual migraines.
Hormone levels change during the menstrual cycle, pregnancy, and menopause, and are also affected by oral contraceptives and hormone replacement therapies.
A variety of medications and complementary treatments are used to relieve headaches. Women who experience hormonal headaches often find relief during pregnancy or upon reaching menopause.
Headaches, especially migraine headaches, have been linked to the female hormone estrogen. Estrogen controls chemicals in the brain that affect the sensation of pain, and a drop in estrogen levels can trigger a headache. Hormone levels fluctuate for a variety of reasons, including:
Levels of estrogen and progesterone fall to their lowest levels just prior to menstruation.
Estrogen levels rise in pregnancy. Many women who have hormonal headaches find they go away during pregnancy. However, some women experience their first migraines during early pregnancy and find relief after the first trimester. After giving birth, estrogen levels fall rapidly.
Perimenopause and Menopause
Fluctuating hormone levels in perimenopause (the years leading to menopause), cause some women to have more headaches. Approximately two-thirds of women who experience migraines say their symptoms improve as they reach menopause (Womenshealth.gov, 2012). For some, migraines actually worsen. This may be due to the use of hormonal replacement therapies.
Oral Contraceptives and Hormone Replacement Therapy
Birth control pills and hormone replacement therapy can cause hormone levels to rise and fall.
Other Contributing Factors
Genetics are thought to play a role in chronic migraines. People who have migraines tend to have a combination of factors that trigger their headaches. In addition to hormones, these include:
- skipping meals
- too much or too little sleep
- intense lights, sounds, or scents
- severe weather fluctuations
- alcoholic beverages, especially red wine
- too much caffeine or caffeine withdrawal
- processed meats, hard sausages, smoked fish
- monosodium glutamate (MSG), a flavor enhancer
- aged cheeses
- soy products
- artificial sweeteners
The earlier you begin treating your headache, the greater your chances of relief. If it is practical, these simple methods can help:
- Drink plenty of water to stay hydrated.
- Lie down in a dark, quiet room.
- Place an ice bag or cold cloth to your head.
- Massage the area where you feel pain.
- Perform deep breathing or other relaxation exercises.
Complementary treatments include biofeedback and acupuncture.
Medications used to treat hormonal headaches include:
- non-steroidal anti-inflammatory medications (NSAIDs)
- beta blockers, anticonvulsants, calcium channel blockers, antidepressants, magnesium
Pregnancy and Breast Feeding
If you're planning on getting pregnant, think you may be pregnant, or are breastfeeding, discuss all your medications with your doctor. Some headache medications may have a harmful effect on your baby's development. Your doctor may be able to suggest alternatives.
Perimenopause and Menopause
If you're taking hormone replacement therapy medication and are experiencing an increase in headaches, ask your doctor to adjust your dose. An estrogen patch can deliver a low, steady dose of estrogen, which can lessen the frequency and severity of headaches.
If you have regular periods, your doctor may recommend preventive medication beginning a few days prior to your period and lasting up to two weeks. In some cases, daily medication may be required.
Keep a headache diary to track your menstrual cycle, diet, sleep, and exercise habits. This will help identify possible triggers.
If you take oral contraceptives, ask your doctor if you can:
- Switch to a regimen that includes fewer or no placebo days.
- Take pills with a lower estrogen dose.
- Take low-dose estrogen pills in place of the placebo days.
- Wear an estrogen patch on placebo days.
- Switch to progestin-only birth control pills.
If you don't currently take birth control pills, ask your doctor if they might reduce your hormonal headaches.