Migraines and hormones: What is the link?

Women who suffer from migraines are thought to have very sensitive nervous systems. Common events, such as sitting in a brightly lit room, can put them in agony for hours or days.

Experts point to a common trigger in these hyper reactions: hormonal changes. “At least 60 percent of women with migraines identify their menstrual periods as a trigger for headaches,” says Colleen Tomcik, MD, a neurologist at University Hospitals Neurological Institute.

This may explain why women are three times more likely than men to get migraines.

A decrease in natural painkillers

The greatest vulnerability for a menstrual migraine occurs between two days before and three days after the start of the menstrual flow. This is the same point in a woman’s cycle that her estrogen levels sharply fall.

But what causes the headaches? Dr. Tomcik says one reason is that estrogen levels affect brain chemicals, such as serotonin, that act as natural painkillers.

“When estrogen levels fall, so do levels of these natural painkillers,” she says. “A woman then becomes more sensitive to other headache triggers, such as bright lights.”

Another type of migraine occurs during menstruation rather than before. These migraines may be tied to high levels of substances called prostaglandins, in addition to low estrogen levels. A woman’s body naturally releases prostaglandins during her period. Prostaglandins cause contractions of the uterus, changes in blood vessels and increased sensitivity to pain.

About two-thirds of women with migraines say their headaches improve after natural menopause. Estrogen levels naturally become more stable after a woman’s menstrual periods end.

How to stop the pain

Most migraine sufferers can avoid or relieve pain through various approaches and treatments. Dr. Tomcik says one important step is avoiding headache triggers.

Migraines are more likely to occur in response to several triggers that occur at once. According to Dr. Tomcik, these are some common triggers:

  • Alcohol
  • Chocolate
  • Food additives, such as nitrates and MSG
  • Smoke
  • Perfume or cologne
  • Bright lights
  • Changes in sleep patterns
  • Hunger

A healthy lifestyle can be helpful as well. “Exercising regularly and reducing stress may decrease tension, which tends to worsen migraines,” says Dr. Tomcik. “Biofeedback and relaxation techniques also work for some women.” Drug therapy can help prevent or block migraines. Choices include over-the-counter and prescription pain relievers, daily preventive medications, herbal remedies and supplemental estrogen for premenopausal women.

Colleen Tomcik

Neurologist, University Hospitals Neurological Institute
Assistant Professor, Case Western Reserve University School of Medicine

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