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 other 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. A drop in estrogen levels can trigger a headache. Hormone levels change for a variety of reasons, including:
Menstrual cycle: Levels of estrogen and progesterone fall to their lowest levels just prior to menstruation.
Pregnancy: Estrogen levels rise in pregnancy. For many women, hormonal headaches go away during pregnancy. However, some women experience their first migraines during early pregnancy and then 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. For some, migraines actually worsen. This may be due to the use of hormone replacement therapies.
Oral contraceptives and hormone replacement therapy: Birth control pills and hormone replacement therapy can cause hormone levels to rise and fall. Women whose migraines come as a result of hormonal changes while on the pill typically have migraine attacks during the last week of the cycle, when the pills do not have hormones.
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
- getting too much or too little sleep
- intense lights, sounds, or smells
- severe weather changes
- alcoholic beverages, especially red wine
- too much caffeine or caffeine withdrawal
- processed meats, hard sausages, and smoked fish
- monosodium glutamate (MSG), a flavor enhancer
- aged cheeses
- soy products
- artificial sweeteners
The main characteristic of a hormonal headache is a headache or migraine. Still, many women experience other symptoms that can help doctors diagnose them with a hormonal headache.
Menstrual or hormonal migraines are similar to a regular migraine and may or may not be preceded by an aura. The migraine is a throbbing pain that starts on one side of the head. It may also involve sensitivity to light and nausea or vomiting.
Other symptoms of hormonal headaches include:
- loss of appetite
- joint pain
- decreased urination
- lack of coordination
- cravings for alcohol, salt, or chocolate
The earlier you begin treating your headache, the greater your chances of relief are. These 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.
Biofeedback can help you learn to relax certain muscles to reduce headache frequency or pain. Your doctor may also recommend that you take magnesium supplements, which can help reduce headache intensity. Reducing stress in your life can also help prevent headache or migraine attacks. Additional treatments include acupuncture and massage.
Some medications focus on acute treatment. These medications are taken once a headache or migraine attack has started. Examples include:
- over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen
- triptans, which are migraine-specific medications that can reduce the intensity of a migraine attack
For women who experience frequent hormonal headaches, preventive therapy and medications may be used. These medications may be taken daily or before the time in your cycle when you know you’re most likely to get a hormonal headache. These medications include:
- beta blockers
- calcium channel blockers
If preventive medications are unsuccessful, your doctor may prescribe you hormone therapy. You may be given estrogen to take daily through a pill or a pitch.
Birth control pills are commonly used to even out hormones and reduce hormonal headaches. If you’re taking any form of hormonal contraceptive and experience hormonal headaches, your doctor may change your dosage. Depending on the problem, your doctor may switch you to a medication with a lower dose of estrogen to reduce your symptoms.
For some women, doctors recommend starting the next birth control pack early. That means skipping the hormone-free placebo pills in the last week of the pack. Doctors typically advise this for three to six months at a time, which can reduce the frequency of attacks.
When you’re pregnant or breastfeeding
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 harm your baby's development. Your doctor may be able to suggest alternatives.
During perimenopause or menopause
If you take hormone replacement therapy medication and experience 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. This would begin a few days prior to your period and last up to two weeks. In some cases, daily medication may be required.
Keep a headache journal 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, consider asking your doctor if taking them might reduce your hormonal headaches.
People who experience migraines in general are much more likely to experience:
- sleep disturbances
Women with frequent hormonal headaches or menstrual migraines are just as susceptible to these complications.
Oral contraceptives and estrogen are safe for many women to take, but they’re also associated with a slightly higher risk of stroke and blood clots. Women with high blood pressure or family history of stroke are particularly at risk.
Seek emergency medical attention immediately if you experience a sudden, severe headache and symptoms such as:
- stiff neck
- shortness of breath
- loss of vision
- any other drastic symptoms