According to a Lancet review, menstrual migraines are more severe than migraines at other times of the cycle.
Possible drivers of menstrual migraines include estrogen withdrawal at the end of the cycle, plus an estrogen-dependent release of prostaglandins and histamine. Body-identical progesterone may help to shelter the brain from estrogen withdrawal and reduce the frequency and intensity of menstrual migraines.
How hormones affect migraines
Menstrual migraines are more common with high, fluctuating estrogen and relatively low progesterone, such as during perimenopause. That’s why menstrual migraines are more common between the ages of 40 and 55.
High, fluctuating estrogen promotes migraines by 1) stimulating immune cells to produce more prostaglandins and histamine and 2) leading to steep estrogen withdrawal, which disrupts the neurotransmitters serotonin and glutamate.
Tip: New research suggests that migraines may be caused by “plumes” of the excitatory neurotransmitter glutamate moving in waves through the brain.
By reducing glutamate and calming the brain, progesterone may help to prevent menstrual migraines.
Research has also linked high levels of the hormone prolactin to migraines. See my blog post about lowering prolactin.
Natural treatment of menstrual migraines
- Magnesium shelters neurons from glutamate and can reduce the frequency and severity of migraines. Magnesium also stabilizes serotonin receptors, reduces inflammation, and prevents the release of substance P, which is the pain-promoting neurotransmitter. It combines well with taurine, a calming amino acid that can also help to prevent migraines.
- Bioidentical or body-identical progesterone works best when taken during the two weeks leading up to the period and is available as Prometrium or Utrogestan capsules. See the migraine section in my perimenopause book, Hormone Repair Manual. (Note: There’s no progesterone in any type of hormonal birth control because contraceptive drugs are progestins, which don’t improve migraines the way progesterone does.)
- Riboflavin or vitamin B2 may also help to prevent migraines and works by normalizing the production of serotonin and improving the function of the MTHFR enzyme, which has been linked to migraines.
- Melatonin reduces inflammation and can work as well as amitriptyline for migraine prevention.
- A gluten-free diet was found in one study to eliminate migraines in 89 per cent of participants. A possible mechanism is that gluten sensitivity can cause high glutamate by triggering an autoimmune reaction against the enzyme (glutamate decarboxylase) that converts glutamate to GABA.
- Finally, iron supplements can be helpful but only for post-menstrual migraines or end-menstrual migraines, which are caused by the brief iron-deficiency anemia resulting from menstrual blood loss.
Hormonal birth control can worsen migraines
All types of hormonal birth control can worsen migraines, and for women who are prone to migraines, estrogen pills carry a significantly higher stroke risk.
Tip: If you develop a severe throbbing headache on the hormonal IUD, check with your doctor because it could be a rare condition called intracranial hypertension.
