May 21, 2023
Ask anyone who suffers from migraine headaches and they will tell you in no uncertain terms that this is not “just another headache.” Migraine is actually a complex central nervous system disorder and is characterized by long duration headaches (from 4 to 72 hours if untreated) often on only one side of the head and is usually accompanied by sensitivity to both light and sound as well as nausea and vomiting. Family history, age, and a variety of factors can contribute to the likelihood of getting migraines for both women and men but it’s women who will often notice a connection between hormonal changes and headaches.
Although migraines can begin at any age, they typically make their first appearance during adolescence. For both men and women, migraines tend to peak when people are in their 30’s and then in general become less severe as people get older. Research suggests that migraines are heavily influenced by hormonal fluctuations, so it’s no surprise that women are three times as likely as men to suffer from migraines. Many women who have migraines will report having them just before or during their period.
But what about menopause? What is the connection between migraines and menopause?
Many clinicians have long held the opinion that migraines improve during menopause. A study done in 2020 did find that while migraines tend to worsen during the perimenopausal years (the years leading up to true menopause), they typically improve after menopause has been completed. But other, more recent research reviews found that a significant proportion of women who are postmenopausal and seek treatment for headache in clinics are reporting worsening of their migraines after menopause. These conflicting results just serve to underscore that migraine is a complex disease and has many factors that come into play, not just a woman’s hormonal status.
Each woman is different and will react differently to treatment options. In some women, taking hormone replacement therapy can actually worsen headaches, while in other women headaches improve or may have no change at all. For women who are already taking hormone replacement therapy but are still suffering from migraines, some clinicians will prescribe a skin patch that contains estrogen. The patch will deliver a steady, low-level supply of the hormone and this is less likely to make your headaches worse. For women whose hormone replacement therapy makes their headaches worse, their doctor may choose to lower the dose of estrogen or switch to a different estrogen form. Some women, in consultation with their physicians, choose to stop hormone replacement therapy altogether.
There is some good news to report in terms of new treatment options that don’t involve hormones. More progress in the treatment of this debilitating condition has been made in the last couple of years than in the last three decades! In addition to new drugs there are new delivery systems including nasal sprays and injections that promise to be more effective and with fewer side effects than the older medications. Older treatments work best if you are able to take them within 30 minutes of an attack but some of the newer drugs can be given as long as two to four hours into a migraine attack. Non-drug options are also being investigated, with neuromodulation devices that stimulate your nervous system with a low-voltage electrical or magnetic pulse are already on the market and are showing some promising results.
Sometimes, simple lifestyle changes can also help, such as keeping a diary of foods that may trigger your migraines, such as chocolate, aged cheese, or artificial sweeteners. Sleep is very important, so do your best to go to bed and get up at the same time each night and day, eat your meals at regular times to avoid dips in blood sugar, and implement a program of stress control, such as guided relaxation or meditation.
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