Many factors contribute to headaches for both men and women, including family history and age. Women, however, often notice a relationship between headaches and hormonal changes. The hormones oestrogen and progesterone play key roles in regulating the menstrual cycle and may also affect headache-related chemicals in the brain.
Having steady oestrogen and progesterone levels may improve headaches, while experiencing oestrogen and progesterone levels that dip or change can make headaches worse. Though fluctuating hormone levels can influence headache patterns, you’re not completely at the mercy of your hormones. These hormone-related headaches can be controlled and treated.
Many women with migraines report headaches before or during menstruation. Also, because of the changes in oestrogen and progesterone around ovulation, some women report headaches around the middle of the cycle too.
The build-up of oestrogen leading up to your period and/or the significant drop in oestrogen just before your period are the main causes of hormonal headaches. Also, insufficient production of progesterone after ovulation (mid-cycle) and leading up to your period may be contributing to your headache problem.
Over the time you have suffered with these menstrual headaches, you would probably have tried some of these treatments:
- Applied ice to the painful area
- Relaxation exercises
- Taken over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Been prescribed antidepressants and/or beta-blockers
- Been prescribed other prescription medications such as dihydroergotamine.
At the Australian Menopause Centre, we characterise hormonal headaches as either being:
- Oestrogen build up headaches OR
- Oestrogen drop off headaches
Oestrogen build up headaches:
A simple description of a menstrual cycle is as follows:
- The menstrual cycle of most women takes 28 days, however this may vary in some women.
- The first day of menstruation (bleeding) is regarded as day one of your cycle. On day one, both oestrogen and progesterone levels are low and both levels remain relatively low for most of the first half of your cycle.
- However, around day 12 of the cycle, the oestrogen does have a mid-cycle surge just prior to ovulation and then drops off again.
- After ovulation, the oestrogen starts its climb towards the end of the cycle. A day or so before the next bleed, the oestrogen level drops off again.
- The progesterone is expected to keep pace with the increase of oestrogen and is thought to “balance out the oestrogen” and helps to offset the possible side effects of too much oestrogen.
- If there is insufficient progesterone being produced or your oestrogen receptors are overly sensitive to oestrogen, this gradual build-up of oestrogen may cause headaches.
- Other symptoms that may accompany this oestrogen build-up include:
- Fluid retention
- Weight gain
- Skin changes like acne
Oestrogen drop off headaches:
- In relation to the menstrual cycle described above, an oestrogen drop off headache usually occurs just before the bleed starts or just as the bleed starts. A headache may also occur around ovulation time due to the oestrogen surge and consequent drop off.
- Symptoms that may accompany an oestrogen drop-off headache include
- Feeling emotional
- Hot flushes and/or sweats
Through perimenopause and menopause
Both perimenopause and menopause result from a change in hormone production by the ovaries. In perimenopause, hormone headaches are usually due to a significant reduction in progesterone production, resulting in an oestrogen build-up headache. In menopause, the headaches often relate to the low oestrogen level that occurs in menopause.
Treatment and monitoring
Diagnosis of your condition is made by relating your symptoms to your menstrual cycle. A headache calendar will be useful to assist with this. Blood testing is arranged to document the changes that occur in your hormones between day 7 of your cycle (the end of the first quarter of your cycle) and day 21 of your cycle (the end of the third quarter). Other testing may demonstrate your degree of sensitivity to your own hormones.
Treatment may involve one or more of the following:
- Progesterone (either as a capsule, a cream or a troche) usually taken during the second half of your cycle
- Diindolemethane or DIM – extracted from cruciferous vegetables like cauliflower and broccoli – this improves the body’s ability to metabolise oestrogen
- Estradiol (either as a cream or a troche) – usually taken towards the end of your cycle and into the next cycle.
All hormones used are bio-identical and are extracted from wild yam. Each prescription is compounded individually for each patient in order to achieve the ideal dose for your needs.
The Menopause Centre makes every effort to provide comprehensive monitoring while on treatment. Your feedback is encouraged so that this information can be used to provide you with the best outcome.
Symptoms of too much oestrogen:
If the dose prescribed is too strong for your needs you may experience one or more of these symptoms:
- Fluid retention
- Breast tenderness
- Break through bleed
- Feeling overheated
- Weight changes.
Symptoms of too much progesterone:
If the dose of progesterone is too strong for your needs you may experience one or more of these symptoms:
- Feeling tired
- Nipple tenderness