Hormonal Migraine- Treatment and Prevention

Introduction-

Headaches can be caused due to various factors, including genetics and dietary factors, but in women, one major factor is fluctuating hormone levels that cause hormonal or menstrual headaches. Hormonal fluctuations are usually seen during pregnancy, the menstrual cycle, and menopause which cause chronic headaches in women, which can also be affected by contraceptive and hormonal replacement therapy. These headaches usually occur before or during the menstrual cycle. But not only is the menstrual cycle the cause of hormonal headaches, but any change in the hormonal level causes this condition.

What Is a Migraine?

It is a neurological condition with a series of symptoms that include severe pain on one side of the head that is described as pulsating or throbbing pain. Hormonal or menstrual headaches are caused two days before and three days during the menstrual cycle which can be triggered by movements, light, smell, or sound. Seventy percent of people who experience migraine are women and 60 to 70 percent of this population experience migraine during the menstrual cycle.

What Is Estrogen Hormone?

Hormones are produced in the endocrine gland, which is present in the organs, tissues, and bloodstream and is called ‘chemical messenger.’ Estrogen and progesterone are two sex hormones in women, where estrogen aids in the

• Female physical features.

• Sets of puberty.

• Reproduction.

• Affects cholesterol.

• Controls menstrual cycle.

• Protects bone.

The level of estrogen hormone keeps changing; they are at a high level in the middle of the menstrual cycle and a low during the cycle. They drop very low after menopause.

What Is the Relation Between Hormones and Headaches?

Heads in women are usually caused due to changes in the levels of estrogen hormones; these hormones drop immediately before the start of the menstrual cycle. Premenstrual migraines usually occur during or after the menstrual cycle when the estrogen hormones drop to the lowest. These hormonal headaches cease during the period of pregnancy.

What Are the Causes of Menstrual or Hormonal Headaches?

Hormonal headaches are usually caused due to drop in estrogen; these control chemicals in the brain that controls pain sensation. A drop in estrogen triggers headaches; these hormonal levels drop due to the following:

• Menstrual Cycle:

Estrogen imbalance occurs as estrogen and progesterone drop to the lowest just before the start of the menstrual cycle.

• Pregnancy:

Hormonal headaches fade away during pregnancy as estrogen levels rise rapidly during pregnancy. Very few women experience migraine during the first trimester, and they fade away. However, the estrogen level drops rapidly after labor, resulting in a hormonal headache.

• Perimenopause and Menopause:

During perimenopause (years leading to menopause), hormones fluctuate, which may worsen the headaches. Two-thirds of women who have migraine show improved symptoms towards menopause. But for some, the symptoms worsen as the estrogen level decreases.

• Oral Contraceptive and Hormonal Replacement Therapy:

Birth control pills and hormonal replacement therapy can cause hormone fluctuations. Women who experience migraine attacks due to hormonal changes while on the pill will surely experience migraine attacks during the last week of the menstrual cycle.

• Oophorectomy:

This surgery removes the ovaries, sometimes with hysterectomy or gender-affirming therapy. Removal of ovaries leads to a drop in estrogen levels, resulting in hormonal headaches.

What Are the Contributing Factors?

In addition to hormonal fluctuation, these include

• Skipping meals.

• Getting too much or inadequate sleep.

• Intense light and sound.

• Severe weather changes.

• Alcohols.

• Too much caffeine or sudden withdrawal of caffeine.

• Stress.

• Processed meat, hard sausages, and smoked fish.

• Flavor enhancer.

• Aged cheese.

• Soy products.

• Artificial sweeteners.

What Are the Symptoms of Hormonal or Menstrual Headaches?

The symptoms include:

• Headache that ranges from dull to severe pain.

• Aura before the headache.

• Feeling very warm or cold.

• Nausea or vomiting.

• Noise, light, and smell sensitivity.

• Tender scalp.

• Appetite loss.

• Pale skin.

• Belly pain.

• Blurred vision.

• Dizziness.

• Diarrhea or fever.

Premenstrual Headaches Can Also Show Symptoms Such As:

• Headaches.

• Fatigue.

• Acne.

• Joint pain.

• Peeing less.

• Constipation.

• Lack of coordination.

• Bigger appetite.

• Chocolate, salt, and alcohol cravings.

How Are Menstrual or Hormonal Migraines Diagnosed?

The doctor will establish a history of migraine-related symptoms by-

• Describing the location of the headaches and the severity of the headache, whether it is throbbing, pulsating, or pounding pain.

• Depending on how often the migraine headache occurs.

• Anything that worsens or improves the headache.

• Depending on what medication is taken to relieve the pain and how often it is taken.

• Depends on the activity, food, stressors, or condition that triggers the headaches.

• Family history of migraine headaches.

• Depending on how a person feels before, during, and after the migraine headache.

The doctor may also recommend blood tests and imaging tests such as a CT scan (computed tomography) or MRI (magnetic resonance imaging) to rule out any other cause of the headache. An EEG (electroencephalogram) is also recommended to rule out seizures.

How Are Hormonal Migraines Treated?

Menstrual migraine is usually treated with NSAIDs such as:

• Ketoprofen.

• Ibuprofen.

• Fenoprofen calcium.

• Naproxen.

• Nabumetone.

Treatment with NSAIDs should begin two or three days before the menstrual cycle and should be continued through the cycle to reduce gastrointestinal side effects.

• If the hormonal migraines are due to birth control pills, then changing pills containing a low amount of estrogen or just progestin can improve the condition.

• If the headache is pregnancy-related, doctor consultation is required before taking any medication, as migraine medications are bad for the newborn.

• Triptans- a selective serotonin receptor agonist, can be used in acute migraine treatment.

• People who experience frequent hormonal headaches may use preventive and medication therapy. These medications may include:

• Beta-blockers.

• Anticonvulsants.

• Calcium channel blockers.

• Antidepressants.

• The doctor may suggest hormone therapy if the preventive medications are unsuccessful. The person may be prescribed estrogen daily through pills or a patch. If a person experiences severe headaches again, the dosage should be adjusted, as the estrogen patch can deliver a low, steady dose of estrogen.

• Home Remedies:

Some home remedies that help reduce hormonal headaches are:

• Drink plenty of water and stay hydrated.

• Rest in a dark and silent room.

• Place an ice pack or cold cloth on the head.

• Massage the area of pain.

• Practice deep breathing and relaxation exercises.

What Are the Side Effects Caused by the Medication?

Some medications are taken to treat hormonal headaches, which result in side effects. Some side effects are

• Loss of strength.

• Pain and heaviness in the chest.

• Dry mouth.

• Headache.

• Burning, numbness, or tingling effects.

• Dizziness.

• Nausea.

• Sleepless.

• A sensation of warmth or cold.

How are Hormonal Headaches Prevented?

Doctors recommend preventive medication in case of a regular menstrual cycle, which begins two to three days before the cycle. In severe cases, daily medication is recommended. A journal should be maintained based on the time of headache, sleep cycle, and exercise habits. If oral contraceptives are taken, then:

• Switch to a routine that includes fewer or no placebo days.

• Pills with lower estrogen dosage.

• Estrogen patches should be used during placebo days.

• Switch to birth control pills that contain only progestin.

What Are the Complications and Emergencies?

Some complications that many women experience are:

• Depression.

• Anxiety.

• Sleep disturbance.

Oral contraceptives and estrogen help to deal with hormonal headaches but may also cause other complications, such as a high risk of stroke and blood clots.

Some Emergencies Caused Are:

• Dizziness.

• Stiff neck.

• Rashes.

• Shortness of breath.

• Loss of vision.

Conclusion

Hormonal or menstrual headaches are usually caused due to low levels of estrogen hormone, which women largely experience. These headaches usually occur during the menstrual cycle, pregnancy, and menopause. Hormonal headaches usually occur two to three days just before and during the menstrual cycle and during menopause when there is a drop in estrogen level. These can be treated through medications, hormonal therapy, home remedies, and lifestyle changes.