The Role of Hormones in Migraine
By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD
While there are many factors that contribute to migraine, it is well-researched that there is a relationship between headaches and hormonal changes in women. Migraine is highly prevalent in women, and there is a growing body of evidence regarding the patterns seen in women throughout their life cycle, and how this information can be used for the diagnosis and treatment of migraine [1]. Today we will be diving deeper into the changes in levels of hormones in the body, and how it influences migraine and headaches.
There are two key hormones (chemicals produced in the body that control and regulate the activity of some cells and organs) of the menstrual cycle – estrogen and progesterone. Estrogen is a steroid hormone that is associated with the female reproductive organs. This hormone, also known as estradiol, is responsible for developing female sexual characteristics [2]. Estrogen is involved with various systems of the body, including cardiovascular, bone, and reproductive systems [2]. Similarly, progesterone is a steroid hormone, and it plays a role in the maintenance of the uterus during pregnancy [3]. Progesterone is actually derived from the molecule cholesterol, and plays a major role in the reproductive system. Each phase of menstruation requires a certain set of hormones to allow for normal progression through the cycle, and progesterone is one of those hormones [3].
The higher prevalence of migraine in women is largely attributed to the natural fluctuation of the hormone estrogen [4]. Factors such as cycle changes or fluctuations in estrogen levels can bring on a migraine in women who are migraine-prone. While estrogen appears to be implicated in migraine pathogenesis, the relationship is complex [5]. A 2021 review on the complex relationship between estrogen and migraine, reported that estrogen withdrawal is the most discussed mechanism in the literature [5]. This mechanism describes the association of migraine onset with natural declines in estrogen levels, for example, during menopause and right before menstruation [6]. In addition, the review suggested that women with a history of migraine may have an increased sensitivity to physiologic fluctuations in estrogen levels, and that migraine may be associated with menstruation [5]. According to a 2018 study, changes in estrogen levels may make some cells in the body more sensitive to migraine triggers [7].
Estrogen fluctuations occur during puberty, menstruation, pregnancy, and the peri- and post-menopausal years [1]. A 2006 study reported that migraine attacks are commonly triggered during drops in estrogen levels, which occur before and during the time of menstruation [8]. According to the American Migraine Foundation, more than two-thirds of women with migraine develop symptoms before or during their periods [9]. Attacks during the menstrual cycle may also last longer and be more intense than attacks at other times of the month. Menstrual migraine attacks occur in the few days prior to a women’s period, and during the first three days of flow, when estrogen levels drop [9]. Migraine attacks can also happen during a woman’s period and after, it varies from person to person. On the other hand, menopause is a time when estrogen levels stabilize and involve the loss of menses [10]. The median age of menopause is 51, but it may occur at an earlier age if there is a history of surgical procedures such as a hysterectomy with bilateral oophorectomy (removal of uterus and both ovaries) [10]. The transition to menopause is known as perimenopause, and can be a time where migraine symptoms get worse before they get better [9]. The condition starts with a sudden drop in estrogen levels, which can trigger migraine attacks. Over time, once the individual transitions to post-menopause, their estrogen levels stabilize and migraine attacks are less sensitive to hormonal changes [9].
Hormones are likely to play a role in migraine pathogenesis; however, it may be influenced by other key factors like past medical history, age, genetics and medication history (for example, hormonal therapy) [5]. More research is warranted to understand how estrogen and other hormones affect migraine. If you think your migraine attacks are related to your menstrual cycle, your headache specialist may advise you to keep a headache diary.Your physician can determine whether you have menstrual migraine, and what treatment is appropriate. There are several natural, mainstream and procedural treatments available for migraine related to menstruation, pregnancy, menopause and beyond!
References:
- Todd C, Lagman-Bartolome AM, Lay C (2018) Women and Migraine: the Role of Hormones. Curr Neurol Neurosci Rep 18:42. https://doi.org/10.1007/s11910-018-0845-3
- Delgado BJ, Lopez-Ojeda W (2023) Estrogen. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
- Cable JK, Grider MH (2023) Physiology, Progesterone. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
- Why Your Estrogen Levels Could Be Contributing to Your Migraines. In: Verywell Health. https://www.verywellhealth.com/connection-between-estrogen-and-migraines-4150527. Accessed 28 Mar 2023
- Reddy N, Desai MN, Schoenbrunner A, et al (2021) The complex relationship between estrogen and migraines: a scoping review. Syst Rev 10:72. https://doi.org/10.1186/s13643-021-01618-4
- Yen SSC (1986) Estrogen Withdrawal Syndrome. JAMA 255:1614–1615. https://doi.org/10.1001/jama.1986.03370120092029
- Artero-Morales M, González-Rodríguez S, Ferrer-Montiel A (2018) TRP Channels as Potential Targets for Sex-Related Differences in Migraine Pain. Frontiers in Molecular Biosciences 5:
- Martin VT, Behbehani M (2006) Ovarian Hormones and Migraine Headache: Understanding Mechanisms and Pathogenesis-Part I. Headache 46:3–23. https://doi.org/10.1111/j.1526-4610.2006.00309.x
- Hormonal & Menstrual Migraine. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/hormonal-menstrual-migraine/. Accessed 28 Mar 2023
- Peacock K, Ketvertis KM (2023) Menopause. In: StatPearls. StatPearls Publishing, Treasure Island (FL)