Author: Jenna Fletcher
Hormonal headaches occur due to fluctuations in hormone levels. This can happen due to a drop in estrogen levels or during a period. They can occur as a result of menopause, pregnancy, and the use of oral contraceptive pills.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth.
People may refer to a hormonal headache as a menstrual migraine or premenstrual syndrome (PMS) headache.
This article discusses what hormonal headaches are, the causes, and how to treat them. It also looks at how a person can help to prevent them from occurring.
A hormonal headache may refer to any headache where changes in hormone levels cause the pain or other symptoms to occur.
According to the National Headache Foundation (NHF), hormones are responsible for inducing the pain response. They can act as part of the body’s defenses, alerting a person to an underlying health condition. As a result, people can experience headaches or other pain due to their hormones.
The NHF also states that serotonin acts as a primary hormone trigger in headaches for anybody. However, for females, the way serotonin interacts with estrogen is a prime factor in causing hormonal migraine headaches.
For example, just prior to menstruation, estrogen levels drop, which can trigger a headache.
According to the American Migraine Foundation (AMF), a menstrual migraine is any migraine that starts between 2 days before a period, to 3 days after the period begins.
When a hormonal migraine occurs, it typically presents as a migraine without aura. However, an aura can occur before the migraine begins. The headache pain will often be severe, throbbing, and start on one side or the other.
Other symptoms may accompany the headache, including:
- sensitivity to light
PMS headaches occur before the period and have different symptoms compared to those of a menstrual migraine. A PMS headache will occur before the period and accompany the following symptoms:
- joint pain
- decreased urination
- lack of coordination
- changes in appetite
- cravings for salt, chocolate, or alcohol
According to the AMF, the primary cause of hormonal headaches is a change in estrogen levels.
They also note that the degree of fluctuation, regardless of the amount of estrogen present, is the primary factor that causes a hormonal headache to occur.
A menstrual migraine can occur between 2 days before, to 3 days after the start of menstruation. This is likely due to a drop in estrogen that occurs around this time.
PMS headaches occur before the period begins.
According to Pregnancy, Birth, and Baby, changes in hormone levels can cause many people to experience headaches during pregnancy, especially in the first and third trimester.
They also note that migraine headaches can also worsen for the first few months. This can improve during the later stages of pregnancy as estrogen levels stabilize.
The AMF states that approximately 50% to 80% of pregnant people with migraine experience a reduction in their symptoms.
This may be due to the increased level of estrogen during pregnancy. During pregnancy, a person may experience less frequent and less severe migraine symptoms.
According to the North American Menopause Society, during the period leading up to menopause, people may notice an increase in the number and severity of their migraine symptoms likely due to fluctuations in hormones during this time.
After menopause occurs, however, some people will no longer experience migraine symptoms.
The United Kingdom’s National Health Service (NHS) states that those taking the combined oral contraceptive pill may find that their headaches improve.
However, others report more frequent headaches, particularly in the pill-free week. This is when the estrogen levels drop.
In a 2017 study Trusted Source, the researchers noted that low-dose estrogen contraceptives can help prevent migraine symptoms.
A person should speak with a doctor about the safest form of birth control for them.
Other contributing factors
Earlier research from 2012 Trusted Source states that females are three times more likely than males to experience migraine headaches. This increase in levels is due to the way hormones interact within their bodies.
The study also notes that hormone replacement treatment can trigger migraine headaches.
A person may also find other things can trigger their headaches. This can include triggers such as foods, smells, light, or stress.
Treatment plans for hormonal headaches will often involve preventative care and acute treatments.
They may also include recommendations for self-care and natural remedies, such as using magnesium supplements.
Home remedies and self-care
A person can take steps at home to treat migraine. This may include laying in a darkened room or placing a cool, damp towel over their eyes or forehead.
In addition, some people may find relief from migraine through yoga. A 2021 study Trusted Source found that yoga therapy can improve the quality of life and reduce the frequency for those with migraine.
The NHS also suggests the following:
- eating small and frequent snacks to keep blood sugar levels up
- trying to maintain a regular sleep pattern
- avoiding stress, if possible
Magnesium is a supplement that a doctor may recommend a person take to help prevent hormonal headaches from occurring.
To use magnesium, a person can take it 15 days from the beginning of the period and continue until the next period begins. Though this may not work for everyone, the AMF finds it to be generally easy and safe to try.
The AMF notes that other natural remedies may also aid in treating migraine headaches. However, they stress that any natural therapy should not take the place of medical intervention.
Some therapies they note as having some success include:
- mindfulness training
- supplements of vitamins and minerals
- essential oils
For acute treatment of migraine headaches, there are three general types of medications.
- Tablets: They can include non-steroidal anti-inflammatories (NSAIDs) or fast-acting triptans such as zolmitriptan, almotriptan, sumatriptan, eletriptan, or rizatriptan.
- Injections: These work faster and bypass the stomach, and can include sumatriptan or dihydroergotamine.
- Nasal sprays: These are faster than a pill. However, they are not as fast as an injection. Nasal sprays can include zolmitriptan, dihydroergotamine, and sumatriptan.
A person should speak with a doctor about the recommended treatment options if hormonal headaches persist.
The AMF also states that some doctors may recommend additional therapies, including:
- stress reduction
- yoga or meditation
- avoiding other triggers
Although acetaminophen is often considered safe, those who are pregnant or nursing should not take any medication before discussing it with a doctor.
Treatment during both perimenopause and menopause will follow a similar approach and include both acute and preventative care.
According to a 2018 study Trusted Source, doctors may need to take some precautions when treating those going through perimenopause and menopause, and take into account other aspects of their overall health.
For example, some people are more likely to develop cardiovascular disease, making treatment with triptans less safe due to how they interact with the cardiovascular system.
A person should speak with a doctor about the best treatment approach during menopause.
Prevention can include medications that reduce the likelihood of a migraine from occurring, as well as making lifestyle changes.
According to the AMF, healthcare professionals may prescribe preventative medications that are off-label. In other words, they are not specifically designed to prevent migraine, but they may help.
Common medications for prevention include:
- Hormones: These come in various forms such as oral, gels, or patches that help prevent a drop in hormone levels leading up to menstruation.
- NSAIDS: A person can take these approximately twice a day in the week leading up to menstruation.
- Magnesium supplement: A person can start taking these on the 15th day of the cycle and continue until menstruation starts.
- Triptans: A person can take these twice a day during menstruation. They may help prevent hormonal headaches from occurring.
Another option is for a person to use continuous hormone therapy, often in the form of hormonal birth control. This approach may help regulate hormone levels and prevent headaches from occurring.
Finally, a person can take steps to avoid other triggers that may contribute to their migraine. This can include:
- eating a healthy diet and avoiding foods that may trigger an attack
- regular exercise
- reducing stress
- avoiding other external triggers
If symptoms are new or worsening, a person should speak with a doctor about either starting a treatment or changing their treatment plan.
A person should speak with a doctor before making any changes to their current treatment.
Hormonal headaches, also known as menstrual migraine headaches or PMS headaches, occur due to drops in estrogen levels.
The symptoms are similar to migraine, with a severe, throbbing headache and, often, nausea or vomiting. Premenstrual headaches can occur alongside symptoms including fatigue, joint pain, acne, and more.
Treatment can include lifestyle changes, preventative medication, and acute symptoms management. Many people will see symptom relief when they are pregnant or reach menopause.