Menstrual or hormonal migraines are the result of 1) estrogen-induced high histamine, and 2) altered levels of neurotransmitters when both estrogen and progesterone drop at the end of the cycle.
Natural treatments for hormonal migraines include oral micronized progesterone and magnesium. The synthetic estrogen and progestins of hormonal birth control are usually not a good idea.
Hormonal birth control can cause or worsen migraines
All types of hormonal birth control can worsen migraines but combined estrogen pills are particularly bad and carry a higher stroke risk for migraine-sufferers than for other women.
Tip: If you develop a severe throbbing type of headache on the hormonal IUD, check with your doctor because it could be a condition called intracranial hypertension.
The role of glutamate in migraines
New research suggests that migraines may be triggered by “plumes” of the excitatory neurotransmitter glutamate moving in waves through the brain.
The solution is magnesium, which helps to prevent migraines, probably by sheltering neurons from glutamate. Magnesium also stabilizes serotonin receptors, reduces inflammation, and prevents the release of substance-P, which is the pain-promoting neurotransmitter involved in migraines. It combines well with taurine, a calming amino acid, that can also help migraines.
How estrogen affects migraines
Estrogen affects menstrual migraines in two ways. First, too much estrogen can cause mast cell activation and high histamine, which can worsen migraines. Second, a drop from high to low estrogen at the end of the cycle can alter levels of serotonin, glutamate and other neurotransmitters.
The solution is progesterone, which reduces histamine and calms the brain and reduces glutamate. Oral micronized progesterone is available as Prometrium or Utrogestan capsule and taken at bedtime during the two weeks before the period. For more information about progesterone, see the migraine section in my new perimenopause book Hormone Repair Manual.
Tip: There’s no progesterone in any type of hormonal birth control. Contraceptive drugs are progestins, which don’t have the same benefits.
Other migraine solutions
Magnesium and progesterone are the best natural treatment for migraines. Here are a few other options.
- 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 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 percent 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.