Hormonal Migraines

By Dr Hazel Batten, Integrative GP at Remede Wellness Medicine

What causes them?

Hormonal migraines are typically caused by fluctuations in hormone levels, particularly oestrogen. They can occur at various times throughout the menstrual cycle. Most commonly they occur before or during a period due to the rapid decline in oestrogen during this time. They are also more common in the perimenopausal stage of life when there is a fluctuating and higher level of oestrogen in comparison to a relatively low progesterone. High, fluctuating oestrogen stimulates an increase in prostaglandin and histamine and the withdrawl of oestrogen disrupts the neurotransmitters serotonin and glutamate.

Natural Treatments

• Magnesium can work by targeting the different neurotransmitters involved in triggering the migraine. It can also reduce inflammation.
• Omega-3 fatty acids can help to reduce inflammation
• Vitamin B2 works on improving serotonin production
• CoQ10 works by lowering levels of a peptide in the brain that is associated with pain and inflammation
• Iron supplements can be helpful for post- menstrual migraines, which can be caused by temporary iron deficiency
• Herbs such as feverfew can work by blocking serotonin and prostaglandin receptors
• Nutritional support such as low histamine diets or gluten free diets can be of benefit
• Complementary therapies such as acupuncture or osteopathy can help to relieve discomfort
• Stress management such as yoga, meditation, breathwork
• Sleep
• Maintaining hydration

Pharmaceutical Treatments

• Oral micronized progesterone can shelter the brain from oestrogen withdrawl and therefore reduce migraines. Progesterone helps regulate histamine by preventing its release and improving the diamine oxidase enzyme responsible for breaking down histamine. It can be used cyclically in the luteal phase or daily throughout the menstrual cycle in the perimenopause period.
• Oestrogen supplementation in the perimenopause period can be helpful as it stabilises the oestrogen levels throughout the cycle and avoids the drop in the premenstrual phase. However, it may make things worse.
• Melatonin can reduce inflammation
• The combined oral contraceptive pill (COCP) – this can vary. Some people find that it can help to regulate their hormone levels, therefore avoiding a migraine. However, in some, they can make the migraines worse. COCPs are contraindicated in migraines with aura due to the increased risk of stroke.
• Triptans e.g sumatriptan, work by narrowing blood vessels in the brain and blocking pain pathways
• Beta blockers can be effective if the migraines are frequent and severe
• Amitriptyline can help to reduce pain
• Anti-seizure medication