Approximately 36 million people in the U.S. suffer from migraine headaches, most commonly between the ages of 18 and 55. Women are disproportionately affected by this, with 18% of women suffering from regular migraines (as opposed to 6% of men). One of the main identifiable causes of migraine is fluctuating hormones. This may explain why women of reproductive age who are menstruating are likely to experience menstrual migraines. And, because birth control pills and other hormone-based contraception are so common during this time, researchers are also examining the relationship between contraception and headaches. There are some ways, however, that women can help prevent and treat their menstrual migraines.
What are menstrual migraines?
One in seven women who experience migraine experience what is known as menstrual migraines. This is a migraine that is centered around a woman’s menstrual cycle. Menstrual-associated migraine is a type of migraine that occurs not only around a woman’s period but also at other times during the month. Menstrual migraines can have the following symptoms:
- Blurred vision
- Nausea (with or without vomiting)
- Sensitivity to light and sound
- Extreme hunger or no appetite
- Poor sleep
- Inability to concentrate
Can hormones cause menstrual migraines?
Levels of estrogen and progesterone fluctuate naturally as women age, regulating menstrual cycles and reacting to pregnancy. This increase and decrease in hormones affects the brain chemistry in women, potentially triggering menstrual migraines.
Hormone-based contraception (e.g., birth control pills, implants, patches, shots, and rings) also add varying amounts of each hormone to a woman’s body. To further complicate things, each type of contraception has different potential side effects, and it may take some time before an effective and safe method is chosen. This can lead to an increase in menstrual migraines as a woman and her doctor work through their choices.
Why do I get a headache when I have my period?
During the time when women are starting families and perhaps also juggling a career, hormones kick in and begin to increase the likelihood of menstrual migraines. However, women who enter perimenopause at an earlier age (average age of menopause is around 51 years) may also see an increased risk of migraine headaches after age 40 due to changes in estrogen production. Even after menopause is complete, hormone cycles will continue, so the potential for migraine triggered by hormones, although decreasing with age, is still present.
Women experience migraine at the following rates during their reproductive years:
- 20 to 24 years: 22%
- 25 to 29 years: 28%
- 30 to 34 years: 33%
- 35 to 39 years: up to 37% of women
Can birth control cause headaches or migraines?
Unfortunately, yes. Sixty-eight percent of women who stopped taking hormonal contraception cited side effects such as migraine as their main reason for stopping. Of these 68%, 80% did not replace their hormonal contraception with another effective method, directly resulting in 20% of the 3.5 million unplanned pregnancies in the U.S. annually.
Fluctuating estrogen levels have long been connected with an increased risk of headache in general and migraine with aura specifically. Numerous studies have shown that women who suffer from migraine with aura (approximately 5% of migraine in women) have a significantly elevated risk of ischemic stroke. Additionally, estrogen-based birth control has been shown to increase the risk of stroke in women who utilize this form of contraception. Combined, these two factors (migraines with aura and estrogen-based contraception) elevate the risk of stroke in women to dangerous levels. For women who smoke while on estrogen-based birth control, the risk is even higher.
There is clear evidence that contraception can increase a woman’s risk of migraine and other dangerous side effects, but there is a chance that hormone-based contraception is still an option. In addition to being 99% effective when used correctly, this form of contraception offers various health benefits that women would not otherwise have, specifically relief of some types of pelvic pain and lower chance of polycystic ovary syndrome. We’ll talk about some ways to manage and prevent pain from menstrual migraines later on in this post.
What’s the difference between migraines versus headaches?
There are important differences in the types of head pain, differences that are necessary to acknowledge for an accurate diagnosis. A headache consists of head pain only, is typically short-lived, and easily resolved with over-the-counter (OTC) medicines. Migraines are more involved neurological conditions that have other symptoms such as dizziness, fatigue, sensitivity to light and sound, and nausea. Migraines, including menstrual migraines, are usually long-lasting and recurring. Episodes with aura also feature visual symptoms in addition to pain and other physical symptoms. These are less common. An accurate diagnosis of the type of head pain you’re experiencing can help your doctor figure out if the pain is connected to menstruation or hormone-based contraception.
Migraines also have up to four predictable phases that distinguish them from other types of headaches. These phases include the following.
Phase 1: Prodromal
This is an early warning system of migraine. Sufferers may be fatigued or irritable, or they may experience food cravings or hunger. This phase can last for several hours or several days prior to a migraine.
Phase 2: Aural
This phase occurs only for those who have migraine with aura. Migraine with aura has additional visual symptoms. People who experience this type of migraine may see spots, flashes of light, or objects that shake or move. They may also have the sensation of pins and needles in their arms and legs, experience problems with speech, or experience odd smells. This type of migraine is more rare, affecting just 5% of people with migraine.
Phase 3: Attack
Symptoms are full-blown during this time. Sufferers may be unable to participate in daily activities during the attack phase. Migraine duration varies from several hours to several days.
Phase 4: Resolution
The migraine may be gone, but fatigue and irritability may linger. Some migraine sufferers may experience a feeling of elation, as they are no longer in pain or experiencing other symptoms. The following videos shows these phases in more detail.
How to prevent menstrual migraines?
An accurate diagnosis is the first step in preventing menstrual migraines. Diagnosis of menstrual migraine is a matter of finding the pattern and analyzing it. Hormone levels can also be checked in conjunction with migraine pain. For women whose menstruation serves as a trigger for migraine, this cycle can become very predictable. To that end, there are ways to help prevent and treat menstrual migraines.
Check your diet
When food cravings hit before and during menstruation, it is tempting to give in and stuff ourselves with chocolate and salty, fatty foods. But this may be increasing both the chances of migraine and the duration and intensity of symptoms. Take 30 days and eliminate as much of the following as you can: sugar, gluten, artificial ingredients and preservatives, and dairy.
An easy way to remember what’s best for you is to stick with foods that don’t come in a box or a bag. Whole foods including plenty or fruits, vegetables, and whole grains help eliminate inflammation in the body and reduce cravings.
Water may also not be the answer to the problem of menstruation migraines, but it can increase energy and eliminate symptoms related to dehydration (e.g., fatigue and muscle soreness).
Lower your stress levels
Stress can be a trigger for menstrual migraines, and chronic stress contributes to other more serious conditions such as cardiovascular disease and diabetes. Monitor stress levels and keep them down by including daily exercise in your routine. This can be meditative exercise, such as yoga or t’ai chi, or it can be more vigorous exercise such as hiking, walking, biking, or swimming. Aim to break a sweat daily for the best, most consistent stress relief.
And, take a break. In many cultures, the time of menstruation is a time when women relax and allow their bodies to restore their balance. Implement this in your monthly routine by taking a break from your hectic schedule to relax, renew, and rejuvenate yourself. This could mean getting a massage, taking the day off, sleeping in a little later, or relaxing with a book or a cup of tea. Many will argue that they don’t have time to take a break every month. But, if you suffer from menstrual migraines, your body will take a break one way or another. Might as well beat it to the punch and plan a soothing, restorative ritual.
Rethink your birth control
If you are taking hormone-based contraception (e.g., birth control pills, patches, rings, or implants), talk to your doctor about your menstrual migraines and see what she or he suggests. Headaches may be a normal part of your menstrual cycle, but migraines are not. An accurate diagnosis is key. If you are experiencing headache with other migraine symptoms, make an appointment with your OB/GYN. If you are currently taking hormone-based contraception and suffering from menstrual migraines, there are steps you can take.
Ask about low-estrogen options. Low-estrogen birth control may be a good option for women who suffer from migraines due to hormone fluctuation. This low dose stays steady throughout the month.
Use back-up birth control if necessary. If you stop taking hormonal contraception, or if your doctor advises you to do so, use a back-up method of birth control while you are finding a solution to migraines caused by contraception.
The following video talks about more ways to prevent migraines.
What are some menstrual migraine treatments?
For some women, these tips may not be enough to prevent migraines. Doctors may recommend treating menstrual migraines with certain targeted types of birth control. Other treatment options for migraine include the following:
- Preventative treatments: Beta blockers, anticonvulsants, calcium channel blockers, magnesium supplements, and antidepressants have all been proven effective in the prevention of migraines.
- Migraine medications: Pain relievers (both prescription and over-the-counter), triptans, and utilizing other migraine medications can all work together to help relieve symptoms during a migraine. Your doctor will have the most information on the medications that could work for you.
- Complementary medicine: Acupuncture, meditation, and biofeedback can work together with other traditional methods of treatment to relieve symptoms and shorten the duration and intensity of migraines.
Finally, it won’t help prevent them, but advocacy for research into menstrual migraines and birth control may make better options available in the future.
That migraine and hormones are connected in women has been made very clear in the research. More emphasis should be placed on finding viable, safe, and effective options for women with regard to hormone-based contraception. Unplanned pregnancy brings high risks to women in the short and long term in terms of educational attainment, poverty level, and overall satisfaction in life. The rate of unplanned pregnancy in the lowest level of income is five times that of the highest level of income. This potentially continues a cycle of poverty, and women without a high school diploma were most likely to have an unintended pregnancy.
Unplanned pregnancies may also result in low birthweight babies and preterm birth, as women may not realize they are pregnant and may not get prenatal care. Implants, rings, and other hormone-based birth control can help to protect women from unintended pregnancy. This helps ensure that when they are ready and able they will be happy, healthy mothers of planned children. Caring for women in this way during their reproductive years is crucial. Research should continue to focus on developing safe, easy, and effective contraception for women that doesn’t lead to menstrual migraines.
If you suffer from menstrual migraines, a pain doctor in your area could help you get a correct diagnosis. Click the button below to find a doctor near you.