Most headaches in women are caused by hormones. At least 5 million women experience hormone headaches each month, say researchers.
According to Dr Anne MacGregor at the National Migraine Centre, more than half of women who get migraines notice a link with their periods. These so-called menstrual migraines tend to be particularly severe.
“Migraine is most likely to develop in either the two days leading up to a period or the first three days during a period. This is because of the natural drop in oestrogen levels at these times. The attacks are typically more severe than migraines at other times of the month and are more likely to come back the next day,” she says.
Periods aren’t the only trigger of hormone headaches. Other causes are:
- The combined oral contraceptive (COC) pill. Some women find their headaches improve while they’re on the pill, but others report more frequent attacks especially in the pill-free week when oestrogen levels drop.
- The menopause. Headaches usually worsen as you approach the menopause, partly because periods come more often and partly because the normal hormone cycle is disrupted.
- Pregnancy. Headaches can get worse in the first few weeks of pregnancy, but they usually improve or stop completely during the last six months. They don’t harm the baby.
How do you know if it's your hormones?
It’s worth keeping a diary for at least three menstrual cycles to help you check whether your migraines are linked to your periods. If they are linked, a diary can help to pinpoint at what stage in your cycle you get a migraine.
How you can help yourself
If keeping a diary reveals that your headaches develop just before your period, you can take steps to help prevent a migraine:
- Eat small, frequent snacks to keep your blood sugar level up, as missing meals or going too long without food can trigger attacks. Have a small snack before going to bed and always eat breakfast.
- Try to get into a regular sleep pattern. Avoid too much or too little sleep.
- Try to avoid stress. If this proves difficult, develop ways to deal with stress, such as taking regular, vigorous exercise and using relaxation strategies.
How your doctor can help
If you have regular periods, menstrual migraines may be eased by taking extra oestrogen before your period is due and for a few days during your period. A doctor has to prescribe oestrogen supplements, which can be a gel to rub into your skin or a patch to stick on your skin.
Your doctor can also prescribe anti-migraine medicines for you to take around the time of your period. These don’t contain hormones, but they can help to stop the headaches developing. They include tablets called triptans and a type of painkiller called mefenamic acid.
Talk to your doctor if you think your contraceptive pills are making your migraines worse. If you have headaches during the days you don't take the pills, you can avoid the sudden fall in oestrogen by taking several packs continuously without a break.
Read more about the contraceptive pill.
The hormone changes that happen as women approach the menopause mean that all types of headache, including migraines, become more common.
Hormone replacement therapy (HRT) can be helpful to treat flushes and sweats, but if you have migraines it’s best to use patches or a gel as these types of HRT keep hormone levels more stable than tablets and are less likely to trigger migraines.
Read more about HRT.