Hormonal Migraines

What are Hormonal Migraines?

Hormonal migraines, or menstrual migraines, are a specific type of migraine headache that occurs with hormonal changes in a person's body, primarily related to the menstrual cycle. These migraines typically affect people who menstruate and are closely linked to the fluctuations in oestrogen levels that occur during the menstrual cycle. Dr Samra’s book The 30-Day Migraine Challenge devotes a chapter to this interesting topic and includes many useful natural and potential hormone solutions. However, hormonal solutions would necessarily involve prescriptions from a qualified medical practitioner.

Risk Factors for Hormonal Migraines

Hormonal migraines predominantly affect women, particularly those of reproductive age. They often begin in the days leading up to menstruation (the premenstrual phase), during menstruation, or shortly after menstruation ends.

Individuals with a personal or family history of migraines are also at a higher risk of experiencing hormonal migraines.

Causes of Hormonal Migraines

• Hormonal Fluctuations: The primary cause of hormonal migraines is the fluctuation of oestrogen levels. Oestrogen is a female sex hormone that plays a role in regulating blood vessels in the brain. When oestrogen levels drop, it can trigger migraines in susceptible individuals.
• Menstrual Cycle: The hormonal changes that occur throughout the menstrual cycle can trigger migraines in some women. Hormonal shifts before menstruation (the luteal phase) and during menstruation itself are common times for migraine attacks.
• Hormonal Birth Control: Some forms of hormonal birth control, such as oral contraceptives, can influence oestrogen levels and may either alleviate or exacerbate hormonal migraines, depending on the individual's response.
• Pregnancy and Menopause: Hormonal changes during pregnancy and menopause can also impact migraine frequency and severity. Some women experience relief from migraines during pregnancy, while others may see an increase in migraine frequency during menopause.

Symptoms of Hormonal Migraines

• Headache: The hallmark symptom of any migraine, including hormonal migraines, is a severe, throbbing headache that is often one-sided and can be accompanied by intense pain.
• Aura: Some individuals with hormonal migraines may experience an aura before the headache. An aura is a visual disturbance that can include flashing lights, blind spots, or zigzag lines. Other sensory disturbances, such as tingling or numbness, can also occur.
• Nausea and Vomiting: Nausea and vomiting are common symptoms during a hormonal migraine attack.
• Sensitivity to Light (Photophobia): People with hormonal migraines often become sensitive to light and may seek a dark, quiet room during an attack.
• Sensitivity to Sound (Phonophobia): Loud noises and certain sounds can exacerbate migraine symptoms.
• Sensitivity to Smells (Osmophobia): Strong odours or specific smells can trigger or worsen hormonal migraines in some individuals.

Types of Hormonal Migraines

Hormonal migraines can be classified into a few subtypes:

• Menstrual Migraines: These occur in relation to the menstrual cycle, typically during the premenstrual phase, menstruation, or shortly after menstruation ends. They are directly linked to hormonal fluctuations, particularly the drop in oestrogen levels.
• Menstrually-Related Migraines (MRM): MRMs occur around the menstrual cycle but may not be strictly tied to hormonal changes. They can include migraines that happen before, during, and after menstruation.
• Pure Menstrual Migraines: These are migraines that occur exclusively in association with the menstrual cycle and are linked to hormonal changes.

Stages of Hormonal Migraines

Migraine attacks, including hormonal migraines, often progress through several stages:

• Prodrome: This pre-migraine phase can occur hours to days before the actual headache. Symptoms during this stage may include mood changes, food cravings, increased thirst, and fatigue.
• Aura (if present): Not all migraines, including hormonal migraines, are accompanied by an aura. For those who do experience auras, this stage involves visual disturbances and other sensory symptoms.
• Headache: This is the most intense migraine phase and can last several hours to days. It's characterised by severe head pain, often accompanied by nausea, vomiting, and sensitivity to light, sound, and smells.
• Postdrome: After the headache phase, individuals may experience a post-migraine phase marked by fatigue, weakness, and cognitive changes. Some people feel drained or "hungover" during this stage.

The stages of a hormonal migraine are similar to those of other migraines. Still, the timing of attacks in relation to the menstrual cycle is a distinguishing feature of hormonal migraines.

Diagnosis of Hormonal Migraines

• Medical History: A doctor will start by taking a detailed medical history, including a history of migraine symptoms and their relationship to the menstrual cycle. Information about the frequency, duration, and severity of headaches is essential.
• Symptom Description: Providing a detailed description of the migraine symptoms, including any visual disturbances (auras), nausea, vomiting, and sensitivity to light, sound, and smells, can help in the diagnosis.
• Headache Diary: Keeping a headache diary that tracks the timing and characteristics of headaches and potential triggers can be very helpful for both the patient and the doctor.
• Physical Examination: A physical examination may be conducted to rule out other possible causes of headaches.
• Neurological Examination: A neurological examination may assess any neurological symptoms associated with the migraines.
• Imaging: In some cases, imaging tests, such as MRI or CT scans, may be ordered to rule out other underlying conditions causing the headaches.

Treatment of Hormonal Migraines

Treatment strategies for hormonal migraines aim to manage symptoms during attacks and, if necessary, prevent future attacks. They can include:

• Acute Pain Relief: Over-the-counter pain relievers like ibuprofen or prescription medications specifically designed for migraines (e.g., triptans) can help alleviate pain during an attack.
• Preventive Medications: Preventive medications may be prescribed in cases of frequent or severe hormonal migraines. These can include beta-blockers, calcium channel blockers, anti-seizure medications, and hormonal therapies.
• Hormonal Management: For some individuals, hormonal management may effectively reduce migraines. This can involve adjusting or stabilising hormone levels using hormonal birth control methods or hormone replacement therapy.
• Lifestyle Modifications: Identifying and managing triggers, practising stress reduction techniques, regular exercise, and maintaining a consistent sleep schedule can help reduce the frequency and severity of hormonal migraines.
• Nutrition and Hydration: Ensuring a well-balanced diet and staying hydrated can also play a role in migraine management.

What if Hormonal Migraines are Untreated?

If left untreated or inadequately managed, hormonal migraines can have several potential consequences:

• Decreased Quality of Life: Frequent and severe migraine attacks can significantly impact a person's quality of life, leading to missed work or social activities.
• Chronic Migraine: Untreated migraines can sometimes progress to a chronic migraine pattern, where a person experiences headaches on 15 or more days per month.
• Increased Healthcare Costs: Frequent migraine attacks may lead to increased healthcare costs due to the need for emergency room visits, medications, and other treatments.
• Migraine-Related Complications: Prolonged or severe migraines can lead to complications such as medication overuse headaches, depression, and anxiety.

Individuals experiencing hormonal migraines must seek medical evaluation and treatment. A doctor can help develop a personalised treatment plan to manage symptoms effectively and improve the overall quality of life. Additionally, managing hormonal migraines can involve lifestyle modifications and stress reduction techniques to help prevent and reduce the impact of these headaches.