Migraines can be a very debilitating condition that is experienced by up to 20% of people worldwide. It might be surprising to know that migraines affect more women more men! It might also be interesting to know that most women with migraines will start to experience them in their teens and into their 20s and will have a decrease in severity and frequency after the age of 55. Can you see where I am going with this. Hormones are possibly the most common migraine trigger in women. Of course hormones are not acting alone and there are many other factors involved, but the majority of women with migraines will get one around the beginning of their cycle. These are called menstrual migraines.
What are menstrual migraines?
Migraines associated with your menstrual cycle have been split into 2 main categories. The first category is the purely menstrual migraines which are only experienced on day 1 and/or 2 of your menstrual cycle. The second category is the menstrual triggered migraines which also occur on day 1 and/or 2 of your menstrual cycle, but may also be experienced on other days throughout the month.
What is really going on during those last few days of your cycle? Well, at the end of your menstrual cycle your estrogen and progesterone (your female sex hormones) significantly drop which triggers your next cycle. Research has shown that it is the drop in estrogen that triggers the migraine rather than a drop in progesterone. How? There are estrogen receptors throughout the body, not just in your uterus or ovaries. Some of these receptors are involved in the production of neurotransmitters and other compounds including serotonin and dopamine. Serotonin is called the happy hormone and dopamine is the pleasure or motivational hormone. As estrogen drops there will be a decrease in serotonin and dopamine levels in your brain leading to the lower mood that women may experience around their period. Estrogen is also involved in the production of opioid-derived compounds, meaning, that as estrogen decreases you will have less of these opioid-derived compounds in your system, therefore, increasing your sensitivity and perception of pain. Dropping estrogen levels are also associated with an increase in inflammation which contributes to the onset of a migraine. All in all, this creates a perfect storm. Decreased mood and increased sensitivity to pain will worsen the intensity of the migraine while the inflammation is linked to triggering the migraine.
You are probably thinking, okay, now what? Where do we go from here? Here are a few key areas that I investigate with people who suffer from migraines.
Hormone levels
Since the drop in estrogen is triggering the migraines it makes sense to investigate where estrogen is at in your body. Do you have too much estrogen which then makes that drop more severe? Do you have too little estrogen which causes the migraines to occur more frequently? Where is your progesterone? Is it balancing out the estrogen or is it too low. These are all key answers that need to be looked into when formulating a specific treatment recommendations.
Sleep
This might be obvious but, when you don’t get a good night of sleep, I am talking 8-9 hours, you are more likely to get a migraine and it is more likely to be more intense. A way to address sleeplessness is through establishing good sleep hygiene (I wrote a whole blog post on this) and using sleep aids if necessary. A 2016 study showed that melatonin decreased number of days with a migraine.
Lifestyle
Factors that support a healthy lifestyle can also decrease migraines. This includes adequate hydration, engaging in some form of movement every single day, balancing stress, maintaining a healthy body weight, and balancing blood sugar levels.
Diet
Many non-menstrual migraines are triggered by particular foods or food ingredients. This may translate into menstrual migraines as well by contributing to mid-cycle migraines or the severity. A trial period of avoiding these food triggers may be warranted. Common food triggers include tyramine rich foods, caffeine, chocolate, wine, and cheese. Figuring out your unique food triggers is essential to good migraine management. Keeping a food journal will help identify food triggers.
Nutrient deficiencies
B vitamins, magnesium, CoQ10, and several others have frequently been linked to migraines. Developing personalized supplemental and nutritional strategies is the best way to address these deficiencies and any underlying causes of them. Migraine medications and birth control and both known to deplete key nutrients that are involved in migraine prevention and in optimal brain health. Looking into medications, but also into your blood work may be key to resolving deficiencies
Herbal support
There are herbs, such as vitex angus-castus, that support hormone balancing that can decrease the symptoms you get just before and after your period including your migraines. Butterbur and Feverfew have been shown to decrease migraines although they have not been studied with respect to menstrual migraines.
Menstrual migraines can be difficult to address due to the monthly fluctuations in hormones and due to the fact that there is almost always more than one contributing factor. Migraine support requires a deep look into a person’s health history and lab work so that the treatment can be highly specific and effective. A Naturopathic Doctor or Functional Medicine Doctor will help you get down to the root cause of your migraines and give you the best treatment recommendations.
If you want to develop a personalized strategy to manage your migraines don’t hesitate to reach out!
Yours in health,
References
Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis.2015;6(3):115–123.
Calhoun AH. Understanding Menstrual Migraine. Headache. 2018;58(4):626-630.
Gonçalves AL et al. Randomised clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. J Neurol Neurosurg Psychiatry. 2016;87(10):1127–1132.
Brandes JL. Migraine in women. Continuum (Minneap Minn). 2012;18(4):835–852.
Sun-Edelstein C et al. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009;25(5):446-452.
Ambrosini A et al. Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation. Acta Neurol Belg. 2013;113(1):25-29.
Shaik MM et al. Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine. Biomed Res Int. 2015;2015:469529.
