According to a new Lancet review paper, menstrual migraines are more severe than migraines at other times of the cycle.
The authors of the paper explain that menstrual migraines are caused by estrogen withdrawal at the end of the cycle together with an estrogen-dependent release of prostaglandins and histamine. They propose progesterone as a possible prevention strategy.
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.
Natural treatment of menstrual migraines
- Magnesium shelters neurons from glutamate and can reduce migraine frequency and severity. 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 also has a migraine-preventative effect.
- Bioidentical or body-identical progesterone reduces the frequency of menstrual migraines. It 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 have the same migraine-reducing effect.)
- 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 reduced inflammation has been found to prevent migraines as well as amitriptyline.
- A gluten-free diet can reduce the inflammation that drives migraines. In one study, a gluten-free diet eliminated migraines in 89 per cent of patients.
- Finally, iron 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 estrogen pills carry a significant stroke risk for women with migraines.
Tip: If you develop a severe throbbing headache on the hormonal IUD, check with your doctor because it could be a condition called intracranial hypertension.