"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)
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:
These hormonal effects don't just change the likelihood of a migraine — they can also affect severity, duration and response to treatment.
Up to 50–60% of women who experience migraine notice a clear pattern related to their menstrual cycle. (Ref: PubMed)
Menstrual migraine typically occurs:
This timing coincides with a rapid fall in oestrogen levels, known as the oestrogen withdrawal hypothesis. (Ref: SpringerLink)
Compared with migraines at other times:
Keeping a headache diary can help confirm whether your migraines are menstrual by tracking timing relative to your cycle.
Migraines don't stay the same throughout life. Hormonal changes at different life stages can alter migraine patterns:
Migraines often increase after puberty, when hormonal cycles begin.
During pregnancy, especially the later trimesters, many women report migraine improvement, likely due to more stable, elevated oestrogen levels.
After childbirth, the sudden fall in oestrogen can trigger severe migraines in some women.
As hormone levels fluctuate more erratically before menopause, migraine attacks may increase in frequency or severity.
Once periods cease and hormones stabilise at lower levels, many women experience reduced migraine frequency, although this is not universal.
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:
Hormones may influence migraine through multiple biological systems:
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)
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)
A headache diary can help you and your clinician pinpoint hormonal links, especially menstrual migraine.
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.
Discuss with your clinician how pregnancy, perimenopause or HRT might affect migraine — especially since changes to hormone therapy can sometimes worsen headaches.
Stress, sleep patterns, diet and hydration can all influence migraines, and often interact with hormonal susceptibility.
Understanding these patterns can help you and your GP develop a more tailored, effective treatment strategy.
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