Hormones, migraines, and perimenopause

Suffering with migraines? You’re not alone. Woman are two to three times more likely to have them than men. Though migraines often have a hereditary component, estrogen fluctuations around your period and during perimenopause can trigger or worsen them. Other hormones can too.

Fluctuating estrogen

In perimenopause (the transition to menopause), the ovaries become less active. As a result, they don’t produce the same levels of sex hormones that you’re used to. During this time of life, progesterone has usually already begun to decline, and estrogen levels fluctuate, too.

Even though estrogen is most often associated with menstrual cycles and reproduction, it has a significant amount of influence in the body. Among other things, it’s tied to bone and heart health and affects constriction of blood vessels. While estrogen itself isn’t responsible for migraines, changes in estrogen can be a trigger and even make migraine pain worse. When estrogen levels fall, blood vessels narrow, which can contribute to the throbbing and aching pain of a migraine. Because estrogen also helps regulate how we process sensation, a sudden decline in levels may also intensify pain.

Migraines with your cycle

According the Migraine Research Foundation, up to 20% of women have issues with menstrual migraines. Menstrual migraines are linked to your cycle and usually crop up just before—or up to 72 hours after—your period starts, when estrogen levels fall. If you’ve always had migraines around your period, you may continue to get menstrual migraines in perimenopause. Or, you may notice migraines for the first time.

Unfortunately, women with menstrual migraines are more prone to migraines as a whole. In fact, two-thirds of women with menstrual migraines get headaches at other times of the month, too. This might be explained by the hereditary nature of migraines. According to the Migraine Research Foundation, a child of a parent with migraines has a fifty percent chance of also suffering from them.

Thyroid hormones

Getting a migraine with your cycle is just one example of how changing hormones play a role as triggers. But it’s important to know that other hormone imbalances may contribute to migraines, too.

Hypothyroidism

Hypothyroidism, or an underactive thyroid, is a condition where your thyroid gland doesn’t make enough of the thyroid hormones your body needs. Not having enough thyroid hormone can be a migraine trigger.

A 2017 study examined people with migraines and made a connection with subclinical hypothyroidism. (Subclinical means an early stage of the condition, before symptoms are easily noticed.) A portion of study participants were treated with levothyroxine, a T4-replacement medication. These patients had marked improvement in their migraines. And, with fewer migraines, they were also able to report a better overall quality of life.

Tests in a full thyroid panel

If you have migraines, talk to your doctor about whether or not you should test your thyroid. Check to make sure that he or she orders a full thyroid panel. It should include:

• Free triiodothyronine, or T3
• Free thyroxine, or T4
• Thyroid stimulating hormone (TSH)
• Reverse T3
• Anti-thyroid antibodies

Insulin resistance

There’s also a link between migraines and insulin resistance, or when the body’s cells stop responding well to insulin. The study Metabolic syndrome and insulin resistance in migraine showed that, as a whole, migraine sufferers have a much higher fasting glucose than those not affected.

Another small study confirmed these results. It looked at 36 healthy, pre-menopausal women. Compared to women with chronic migraines, it showed less insulin resistance in women with infrequent or no migraines.

Checking insulin resistance

If you have concerns about insulin resistance, chat with your doctor. Be prepared to answer questions about your medical history, diet, and family history. And, know that you may be asked to have lab work done. Some tests doctors use to back up a physical exam and assessment are: an oral glucose test, a fasting glucose test (blood draw), and an A1c test to check average blood sugar over the past several months.

Serotonin

Women in their 40s have a lot going on—physical changes, careers, growing kids, aging parents. Trying to keep up with every aspect of a busy life can be stressful. Emotional stress is a well-known migraine trigger for many people. Stress can affect levels of serotonin. Just like estrogen, serotonin can constrict blood vessels. It can also turn on nerve endings and make them more sensitive. Either can make a migraine feel even worse.

Hormonal birth control

Women experiencing a lot of symptoms in perimenopause may hear that hormonal birth control is the answer and that it can bring a lot of relief. It’s true that it can keep your period coming at regular intervals, stop hot flashes, and lessen bleeding. But even though it may help perimenopause symptoms, hormonal birth control may not be a help to your migraines.

The most common contraceptive used by women

In 2014, nearly 10 million women aged 15-44 were using the pill. This made it the most common method of birth control being used by women in the United States. But, even though it’s sometimes presented as a one-size-fits-all solution, it’s not always right for everyone. Migraines are closely linked to hormone fluctuations. Yes, hormonal birth control may help reduce headaches for some women. But the bad news is: it can be a trigger for others.

Why you should talk to your doctor about birth control

It’s a good idea to talk to your doctor about birth control, especially in perimenopause, as your cycle and periods change. You can still get pregnant while you’re moving toward menopause. This is even true if your ovulation and cycles are irregular. There are many options for birth control and migraine management, and yours should depend on your medical history and a number of other factors.

Cautions for hormonal birth control

If you have migraines with auras, you should know: combination birth control pills aren’t for you. Auras are connected with a small increased risk of stroke. And so is the pill. You and your doctor may decide a different form of birth control is best.

Rebound headaches

As we age, many of us have more body aches and pains. If you’re always popping over-the-counter (or prescription) pain relievers, look out. Using short-term pain relief (ibuprofen, aspirin, sinus meds, sleep meds) for more than a few days is a bad idea. It can trigger rebound headaches. Rebound headaches can drag on and are harder to get rid of with overuse over long periods. Even prescribed “rescue” medications can cause rebound headaches if used too much.

Migraine outlook for menopause

For women with menstrual migraines, relief may come with age. About 60% of women with migraines notice changes in menopause. And two-thirds of women will get complete relief, thanks to fewer estrogen fluctuations.

Help for migraines

Migraines in perimenopause are linked with changing estrogen levels, and they can also be triggered by other hormone imbalances. Many providers don’t investigate the root cause of migraines because of the sheer number of possible triggers. But, for women who want more information, an integrative or functional medicine physician may be able to identify patterns and help you find relief.

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