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Migraines and Hormones

Migraines and Hormones: The Missing Link in Women’s Health

J Boora
J Boora

"I've been a pharmacist for over 20 years and have spoken to numerous people, mostly women, about migraines, and never once has the question come up about a link to hormones."

Migraines affect millions of people worldwide, but for women, the link between hormones and migraine attacks is particularly strong and often under-recognised. Migraines are three times more common in women than men, a difference that begins at puberty and continues through reproductive life, pregnancy, perimenopause and beyond. (Ref: PubMed)

Why Hormones Matter in Migraine

Migraines are complex neurological events involving neurotransmitters, nerve pathways and blood vessel regulation. For women, sex hormones like oestrogen and progesterone play a powerful role in modulating migraine susceptibility:

  • Oestrogen influences pain pathways and chemical mediators in the brain (including serotonin and CGRP). (Ref: Hopkins Medicine)
  • Sudden changes, particularly drops in oestrogen, are strongly linked to migraine onset. (Ref: PubMed)
  • Women are especially prone to migraines around times of hormonal fluctuation (e.g., menstruation, pregnancy or perimenopause). (Ref: Mayo Clinic News Network)

These hormonal effects don't just change the likelihood of a migraine — they can also affect severity, duration and response to treatment.

Menstrual Migraine: A Recognised Subtype

Up to 50–60% of women who experience migraine notice a clear pattern related to their menstrual cycle. (Ref: PubMed)

Menstrual migraine typically occurs:

  • From two days before the start of menstruation
  • Up to three days into the period

This timing coincides with a rapid fall in oestrogen levels, known as the oestrogen withdrawal hypothesis. (Ref: SpringerLink)

Compared with migraines at other times:

  • They tend to be longer lasting
  • Often more intense
  • May be harder to treat with standard medications. (Ref: Migraine Trust)

Keeping a headache diary can help confirm whether your migraines are menstrual by tracking timing relative to your cycle.

Hormonal Life Stages and Migraine Patterns

Migraines don't stay the same throughout life. Hormonal changes at different life stages can alter migraine patterns:

Puberty

Migraines often increase after puberty, when hormonal cycles begin.

Pregnancy

During pregnancy, especially the later trimesters, many women report migraine improvement, likely due to more stable, elevated oestrogen levels.

Postpartum

After childbirth, the sudden fall in oestrogen can trigger severe migraines in some women.

Perimenopause

As hormone levels fluctuate more erratically before menopause, migraine attacks may increase in frequency or severity.

After Menopause

Once periods cease and hormones stabilise at lower levels, many women experience reduced migraine frequency, although this is not universal.

Why Some Women Are More Sensitive to Hormone Changes

Not all women experience hormonal migraines. Research suggests that women who do may be uniquely neuroendocrine-sensitive to changes in oestrogen levels, particularly rapid declines, even when absolute hormone levels are similar to those of women without migraine. (Ref: PubMed)

This may help explain:

  • Why migraines are predictably related to the cycle
  • Why some women respond differently to contraceptives or HRT
  • Why pregnancy often improves, then worsens migraines

How Hormones Interact With Migraine Pathways

Hormones may influence migraine through multiple biological systems:

1. Oestrogen and Blood Vessel Regulation

Oestrogen affects chemicals like serotonin that regulate blood vessels and pain signalling in the brain. Fluctuations can trigger vessel instability and pain pathways involved in migraine. (Ref: Johns Hopkins)

2. CGRP: A Key Migraine Mediator

CGRP (calcitonin gene-related peptide) is a powerful pain-mediating molecule released during migraine attacks. Emerging evidence suggests that hormone fluctuations may affect CGRP release, potentially increasing susceptibility, especially during menstruation. (Ref: MedCentral)

Practical Tips for Managing Hormonal Migraines

Track Your Cycle

A headache diary can help you and your clinician pinpoint hormonal links, especially menstrual migraine.

Plan Ahead

Some women benefit from short-term preventatives around predictable hormonal change periods. These are usually triptans, such as Sumatriptan, Rizatriptan and Zolmitriptan, taken a few days before a period begins and continued for 3–5 days.

Others may find that continuous hormonal regimens (e.g., extended-cycle contraception without breaks) reduce fluctuations and help prevent migraines.

Consider Life Stage

Discuss with your clinician how pregnancy, perimenopause or HRT might affect migraine — especially since changes to hormone therapy can sometimes worsen headaches.

Lifestyle & Trigger Awareness

Stress, sleep patterns, diet and hydration can all influence migraines, and often interact with hormonal susceptibility.

Key Takeaways

  • ✨ Migraines affect far more women than men in part because of hormonal influences, especially oestrogen.
  • ✨ Large drops or fluctuations in oestrogen levels are one of the most recognised migraine triggers.
  • ✨ Menstrual migraines are common, predictable and often more severe than other attacks.
  • ✨ Migraine patterns can change at puberty, pregnancy, perimenopause and menopause.

Understanding these patterns can help you and your GP develop a more tailored, effective treatment strategy.

References

  • Systematic review on the influence of estrogen and migraine prevalence. PubMed
  • JAMA review of estrogen, estradiol decline and migraine triggers. JAMA Network
  • Hormonal influences and trigeminovascular interactions in migraine. PubMed
  • Women's Wellness: hormone effects on migraine across reproductive stages. Mayo Clinic News Network
  • Hormone fluctuation and estrogen withdrawal in migraineurs. PubMed
  • CGRP and hormonal impact on migraine susceptibility. MedCentral
  • Menstrual migraine triggers and estrogen data. SpringerLink

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