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

Menopause is the stage of life when you stop having periods. You are said to reach menopause when you haven’t had a period for 12 months. Perimenopause is the period of time leading up to menopause. It can last years for some people.

As you approach menopause, rapid changes (fluctuations) in your hormone levels can be a trigger for migraine attacks. After menopause, you may find your migraine attacks become less severe and less frequent, as your hormone levels settle down. This may not happen immediately – it can take a few years.

Hormone replacement therapy (HRT) can help with symptoms of menopause. Some people find that it can also help with their migraine, but others find it makes their migraine worse. There are many different types of HRT and some types are better for people with migraine.

Alternatives to HRT for menopause symptoms include the contraceptive pill and non-hormonal medicines.

We have more information about menopause and HRT on our migraine and menopause page.

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

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.