Migraine and hormones

Migraine and hormones

Migraine is more common in women than in men. This is because female hormones are a migraine trigger. Women with migraine can find that their menstrual cycle, the menopause and the contraceptive pill have an impact their migraine attacks.

Menstrual cycle

Many women with migraine have their first migraine attack during their teens, often around the time that their periods start. It can be distressing for teenage girls to start their periods and start having migraine attacks at the same time.

Around half of women with migraine say their menstrual cycle directly affects their migraine.

The whole menstrual cycle, not just your period, is associated with biological changes in your body. Studies suggest that migraine attacks can be triggered by a drop in oestrogen levels, which is what happens just before your period starts.

Keeping a diary for at least three months can help show you whether there is a link between your migraine attacks and your menstrual cycle. Show your diary to your GP so that you can discuss how to better manage your migraine attacks.

There is a specific type of migraine called ‘menstrual migraine’ – read more about this and its treatment.

Menopause

Many women find that their migraine becomes less severe and frequent, and may even disappear, by around the age of 50. For some women this is due to the menopause.

From about the age of 40 onwards, women become less fertile as their ovaries gradually stop producing eggs each month. The time from when periods become irregular until they stop is called the peri-menopause. The menopause is when periods stop completely. The average age that women have the menopause is 51 to 52 years.

Some women find that their migraine attacks are still linked to their periods during the peri-menopause. Once a woman’s periods have stopped, the hormonal cycle can continue for years afterwards. This can mean some women continue to get migraine attacks on a monthly basis, even when their periods have stopped. For most women, their migraine attacks settle down two to five years after the menopause.

Some women find their migraine gets worse during the menopause.  However, it seems to vary a lot from person to person, and is impacted by a range of factors.

After the menopause, women may find that migraine triggers that are not related to their hormones become more obvious, or that they develop new migraine triggers, for example neck tension.

The menopause can be a difficult time for women with migraine. The irregularity of your periods can make it harder to cope, as migraine attacks may be more difficult to predict. Also, symptoms of the menopause such as hot flushes and night sweats can mean your sleep is disturbed and you may feel stressed. This can mean you are more likely to have a migraine attack.

Although some women continue to have migraine attacks after their menopause, for most women, when their menopause finishes, they find their migraine is a lot better.

Keeping a diary

Keeping a diary for three months can help you to see if there is a link between your migraine, your periods and your menopausal symptoms. It could be helpful to take your diary to your GP so that you can discuss the best way to manage your migraine and menopause.

Hormone replacement therapy

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause, such as hot flushes and night sweats.

There are risks associated with HRT, but for some women the benefits outweigh the risks.

Having migraine does not mean you can’t take HRT. Some women find it helps their migraine as well as their menopause. However, other women find HRT makes their migraine worse. If you decide to take HRT, it is important to try it for three months to give your body time to adjust.

If you find that HRT makes your migraine worse, speak to your doctor, as a different type of HRT or a different dose may be better for you. It may also help to try different ways of taking HRT, for example using patches or gels rather than taking tablets.

It is usually recommended that you take HRT for a few years. It can have an additional benefit of helping to prevent weakening of the bones (osteoporosis), which is common following the menopause.

Other treatments

Clonidine (Dixarit) is a drug sometimes prescribed to treat high blood pressure. However, it is also licensed to treat hot flushes during the menopause and as a preventive treatment for migraine.

Clonidine is not often given to people with migraine as it isn’t effective in a lot of people. However, it can help some people who have menopause symptoms and migraine, and who can’t or don’t want to take HRT. You should not take clonidine if you have a history of serious depression.

There are a lot of complementary and alternative treatments for menopause symptoms, although there is little scientific evidence to prove they are effective. It is also important to remember that there can be side effects with these medicines, just as there are with regular medicines. If you decide to take any of these alternative treatments, tell your doctor.

The most common complementary/alternative treatments for menopause symptoms are:

• Agnus castus
• Isoflavones
• Evening primroseoil

Surgical menopause

Menopause that is brought on by surgery does not usually improve migraine and it may even make it worse, especially if the ovaries are removed as well as the womb (hysterectomy). If a hysterectomy is needed, the effects may sometimes be reduced by taking HRT.

Contraceptive pill

If you have migraine, you can take the contraceptive pill, but it is important to choose the right one for you and your condition.

Migraine with aura

If you have migraine with aura, you should not take the combined oral contraceptive pill. This is because the combined pill is associated with a very small increased risk of stroke. This risk increases when the pill is taken by women who have migraine with aura.

You can safely take a progestogen-only contraceptive pill instead. And there are other progestogen-only methods that you could consider, such as implants, injections and intrauterine (inserted into the womb) systems.

Progestogen-only methods suit many women, but some find that irregular bleeding is a problem, which can in turn lead to headaches.

Migraine without aura

If you have migraine without aura, you can usually safely take the combined oral contraceptive pill.

If you have other risk factors, such as high blood pressure or a family history of heart disease or stroke, you may be advised not to take the combined pill.

If you start taking the combined pill and find you start getting migraine with aura, you should stop taking the pill, use another form of contraception and speak to your doctor.

The combined pill is taken every day for 21 days and then you have a seven-day break, during which time you have your period. Many women find that when they take the combined pill, their migraine attacks become more painful or more frequent during the week they don’t take the pill.

If this happens to you, speak to your doctor about changing to a different type of pill. Or, you may find that taking the pill continuously for three cycles followed by a four-to-seven day break may help.

You could also consider taking the pill continuously without a break. Guidelines have confirmed that it is safe for women to take the combined pill without a break if they want to avoid symptoms such as headaches.

Taking the pill to reduce migraine attacks

If your migraine is associated with premenstrual syndrome (PMS), you may find that taking the combined oral contraceptive pill or the injectable contraceptive can help reduce migraine attacks during the time just before your period.

Other methods of contraception

There are other methods of contraception that do not involve hormones, for example the coil, condoms and diaphragms. However, the coil can make periods heavier, which can result in migraine attacks getting worse. Speak to you GP or family planning adviser about the best option for you.

Emergency contraception and migraine

Emergency contraception is used to prevent pregnancy after sex. It is usually taken within 72 hours, but is most effective if taken within 12 hours.

Emergency contraception only contains progesterone, which means it can be taken by women who have either migraine without aura or migraine with aura.

Useful organisations

Family Planning Association 

Provide information on relationships and sex education, sexual and reproductive health, and postnatal health and wellbeing.

Website: www.fpa.org.uk

NAPS (National Association for Premenstrual Syndromes)

Provide information, advice and support to PMS sufferers and their families with the express purpose of the condition being successfully managed.

Website: www.pms.org.uk

Women’s Health Concern

Is the patient arm of the British Menopause Society (BMS). They provide a confidential, independent service to advise, reassure and educate women of all ages about their gynaecological and sexual health, wellbeing and lifestyle concerns, including information on migraine and HRT. They also have information on BMS-recognised specialists.

Website: www.womens-health-concern.org