Hormonal changes particularly around the menstrual cycle, the use of birth control pills, the hormonal changes which occur during the first trimester of pregnancy, or the use of exogenous estrogens in the menopause are the most widely known hormonal triggers of migraine headaches.
Causes of Menstrual Headaches
Menstrual headaches are primarily caused by estrogen, the female sex hormone that specifically regulates the menstrual cycle fluctuations throughout the cycle. When the levels of estrogen and progesterone change, women will be more vulnerable to headaches. Because oral contraceptives influence estrogen levels, women on birth control pills may experience more menstrual migraines.
Migraine attacks in women are more likely to occur in the perimenstrual period and occur exclusively so in some women. The acute treatment of menstrual migraine is similar to that of non-menstrually related attacks, but the response to treatment may be less favourable. Perimenstrual prophylaxis, with NSAIDs, triptans or estradiol, is effective in decreasing attack frequency and severity.
The female reproductive system comprises the vagina, uterus (womb), fallopian tubes and ovaries. Hormones secreted by the ovaries and a small gland in the brain called the pituitary gland control the menstrual cycle. The average cycle is around 28 days. After a period, rising levels of the hormone oestrogen help to thicken the lining of the womb (the endometrium). At mid-cycle, an egg is released from one of the ovaries (ovulation). If the egg is unfertilised, falling levels of the hormone progesterone make the womb lining come away. This is called a period, or menstruation. The cycle then repeats.
Treatment options for Menstrual Headaches
It is clear that many factors work together to bring on a migraine attack. Addressing one factor in isolation may not be enough to reduce the frequency and severity of the symptoms. It is important to have your migraine medically investigated, to make sure you get appropriate treatment. Treatment options include:
Dietary changes - such as limiting caffeine, eating regularly to maintain blood sugar levels and avoiding known triggers such as red wine.
Medications - such as painkillers, anti-emetics for nausea, and drugs which act on the blood vessels.
Treating underlying causes - such as high blood pressure.
Stress management - because arteries can be affected by emotional states.
Complementary therapies - such as chiropractic.