Hormones may be to blame for those crippling migraines you're experiencing. We talked to a headache specialist about how to identify whether your migraines are related to hormones, plus actions to take to prevent—or at least lessen the severity of—them.
hormonal migraine pain
Credit: Getty / ljubaphoto

If there's anything that can completely annihilate your day, it's a migraine. Migraines are more than just a "bad headache." They can be an unrelenting wave of pain that doesn't let up for days. Something that sends you into your room for a lay-down in the dark—even when there's work to be done or kids pulling at your side.

For EatingWell senior digital editor Victoria Seaver, M.S., R.D., her migraines didn't start until she went off of hormonal birth control medication. It was then that she began to experience debilitating migraines. But it wasn't just the head pain that made things unbearable. The extreme nausea and vomiting that accompanied each attack would take her out of commission for an entire day. "Once my vomiting subsided, I'd have to lie in bed with a cold washcloth on my head and sleep until I felt better," she says.

Migraines can affect both men and women, but they're far more prevalent in women. More than 39 million people suffer from migraines—and 28 million are women, according to the Migraine Research Foundation. In total, about 20% of U.S. women have migraines.

Why? Credit hormones. ″Female predominance in migraine has been recognized since the ancient times," says Jelena Pavlovic, M.D., Ph.D, a headache specialist with Montefiore Health System in Bronx, New York. That's probably not comforting, but you can gain back some control (more on that later). Hormonal fluctuations, namely in estrogen—which happen during the monthly cycle as well as throughout life—are to blame.

Most severe, says Pavlovic, is "menstrually related" migraine, a series of attacks that pop up one to two days before your period starts and last until the second or third day of your period. Her research in The Journal of Headache and Pain found that 60% of women who have migraines say that their attacks happen around their period. (Though some women may be saddled with the throbbing for longer or shorter than that, she adds.) Unfortunately, ″migraine attacks that occur in relation to your period tend to be the most burdensome and difficult to treat," she says. The ibuprofen that typically zaps a migraine at other times may do next to nada now.

Another snag: Perimenopause. This is the time in your 30s and 40s where estrogen begins to fluctuate during the years before menopause, according to the American College of Obstetricians and Gynecologists. It's these hormonal swings that tend to make migraines more frequent and random, says Pavlovic. Women who had one or two headaches a month may now experience 10, she says. And when they're tough to predict, they're tough to get ahead of and treat effectively.

One bright spot is pregnancy. ″Migraine headaches typically stabilize during pregnancy due to stable and rising levels of estrogen,″ says Pavlovic. Unfortunately, this isn't a permanent change. Once you have your baby, hormone levels will go back to baseline, making you, once again, vulnerable to hormonal swings.

Though it's not understood exactly what's going on with estrogen to make it the primary driver behind migraines, researchers say it's clear that it's indeed the hormone responsible. ″When estrogen is stable, such as on long-term contraception or menopause, or high, such as pregnancy, this tends to be the time of fewer migraine attacks," explains Pavlovic. Give birth or stop hormonal birth control and the estrogen slide can trigger what feels like a new wave of attacks.

How to help prevent—or at least dull—migraines

Diligently tracking migraines, symptoms, triggers and treatments, along with developing a treatment strategy that works for you, can help you grab relief from these hormonal migraines. Here are three must-dos for migraine sufferers.

Know what a migraine is

A migraine isn't just one set of symptoms. It can be on one side of your head or both. It may throb or it may not. And sometimes—but not always—you can get that sensitivity to light and sound and vomiting that is often associated with migraine, says Pavlovic. But not always. And so, if you don't have the classic symptoms, you may never even be diagnosed, she says. Remember, though, the pain isn't normal and you don't have to grit your teeth and make it through.

Keep a headache diary

It's tough to remember exactly what happened two days ago, let along one month ago. Knowing when you had migraines can help you determine predictable patterns for when they arise, so you can be ready. There are many cycle tracking apps, but Pavlovic recommends keeping it on a calendar where you can see days of the week and major holidays and events. Mark when you start your period and when it ends. Include days when you had a headache, how you treated it, and your symptoms.

Treat early

Seaver figured out that when she felt a migraine coming on, she'd take Excedrin right away. That's key. You might delay taking medication in hopes that it will resolve on its own, but that's rarely the case. Prompt treatment prevents the headache from becoming entrenched and more difficult to treat.

″Getting ahead of the attack with a mini-prevention strategy can help with menstrual migraines and other predictable migraines," says Pavlovic. She recommends taking an NSAID, such as naproxen (you'd know it as the brand name, Aleve), twice daily starting on the day you get your first headache or even the day before for five to seven days max. (Naproxen may also be taken along with migraine medications called triptans, a combination that has been found to be more effective than naproxen alone, according to a Cochrane review.) Depending on the severity, you might also need to take a rescue medication if the migraine breaks through. Talk to your doctor about an action plan tailored to you. Relief awaits.

The Bottom Line

If you're experiencing these types of migraines, know that you don't have to suffer through them alone. Talk to your doctor about the symptoms and what you can do to help dull or even prevent hormonal migraines. And while they certainly disrupt your life, the good news is they may go away once your hormones re-regulate.