Migraines are 2-3 times more common in women than in men and the gender difference begins at puberty and often ends after menopause. Many hormone-related events exclusive to women, such as pregnancy, menopause, and the cycles of menstruation can trigger the onset of migraines. Like many health problems that affect women in greater numbers than men, migraines were relatively neglected by medical researchers until fairly recently. And when studies had been done they more often were done using male subjects. Scientists are fairly certain that changing levels of female hormones contribute to migraine; however, exactly how these hormones work is still a mystery.
Approximately 60% of women who chart their migraine attacks will note that their headaches are partly or wholly synchronized with the menstrual cycle. The medical community divides these hormonal migraines into two categories.
- True Menstrual Migraine- attacks that occur two days prior, during and up to three days after the menstrual period and at no other time.
- Menstrually Related – attacks that occur during mid-cycle or around the time of ovulation.
Many women with migraines who suffer from PMS believe their headaches are just another part of PMS. However, scientists believe that PMS and menstrual migraines are separate entities, both driven by a woman’s hormonal cycle and affecting the central nervous system. To further support that they are different syndromes, often the treatment for one does not help the other.
Although charting symptoms is very important, it does not provide the complete picture. Saliva testing which measures free level of hormones in the body provides a precise account of the fluctuations in hormone levels.
Cycle mapping measures both estradiol and progesterone levels at 13 points throughout a 28 day cycle. The health care professional can utilize symptom charting and test results and make a complete evaluation to develop the subsequent plan of treatment which may include prescription hormone replacement therapy.
The most common types of hormone replacement therapy prescribed are Estrogen and Progesterone. Progesterone is the primary hormone treatment of choice for PMS and important for migraine management both pre and post menopause since it helps to balance estrogen levels. Oral extended release tablets are preferred as it is most effective with symptom management.
Estrogen works to increase the level of serotonin and endorphins, as well as other neurotransmitters which aid in migraine management. Although estrogen is not as commonly used in premenopausal women, it is prescribed in certain situations and most often given cyclically. Typically, transdermal dosing is used which maintains a constant level of estrogen in the blood, avoiding the peaks and valleys that appear to trigger the migraine.
Sometimes birth control pills are prescribed, however, these can exacerbate symptoms of PMS and increase the incidence of migraines. Non-hormonal treatments are often prescribed in addition to hormones. Information about these should be obtained from your personal health care professional.