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 estrogen (ES-truh-jen) and progesterone (pro-JES-tuh-rohn), which play key roles in regulating the menstrual cycle and pregnancy, can also affect headache-related chemicals in the brain.

Having steady estrogen levels might improve headaches, while having estrogen levels that dip or change can make headaches worse.

Though changing hormone levels can influence headache patterns, you’re not completely at the mercy of your hormones. Your doctor can help you treat — or prevent — hormone-related headaches.

During menstruation

The drop in estrogen just before your period might contribute to headaches. Many women with migraines report headaches before or during menstruation.

Your menstrual-related migraines can be treated in several ways. Proven treatments for migraines are often effective for treating menstrual migraines. They include:

• Ice. Hold a cold cloth or an ice pack to the painful area on your head or neck. Wrap the ice pack in a towel to protect your skin.
• Relaxation exercises. Try relaxation exercises to lower stress.
• Biofeedback. Biofeedback might improve your headaches by helping you monitor how your body responds to stress.
• Acupuncture. Acupuncture might improve your headaches and help you relax.
• Over-the-counter pain relievers. Your doctor might recommend that you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) or ibuprofen (Advil, Motrin IB, others). These medications might relieve your pain soon after your headache begins.
• Triptans. Your doctor might prescribe these medications that block pain signals in your brain. Triptans often relieve pain from your headache within two hours and help control vomiting.
• Gepants. Your doctor might prescribe from this newer group of medications. Calcitonin gene-related peptide (CGRP) antagonists are effective for treatment of migraine.
• Other prescription pain medications. Sometimes your doctor might suggest other prescription pain medications, such as dihydroergotamine (D.H.E. 45, Migranal). These can’t be taken with triptans.

Preventive treatment

If you have several debilitating headaches a month, your doctor might recommend preventive treatment with NSAIDs or triptans.

If your menstrual cycle is regular, it can be most effective to take preventive headache medication a few days before your period and continue it through up to two weeks after the start of your period.

If you have migraines throughout your menstrual cycle or you have irregular periods, your doctor might recommend that you take preventive medications daily.

Daily medications might include beta blockers, anticonvulsants, calcium channel blockers, antidepressants or magnesium. Your doctor might also consider monthly injections of a calcitonin gene-related peptide monoclonal antibody to help prevent your headaches, especially if other medications aren’t effective. Doctors will likely review other medical conditions you have to determine which medications might be most appropriate for you.

Making lifestyle changes, such as reducing stress, not skipping meals and exercising regularly, also might help reduce the frequency, length and severity of migraines.

Hormonal contraception use

Hormonal contraception methods, such as birth control pills, patches or vaginal rings, might change your headache patterns, improving or worsening them. For some, hormonal contraception can help reduce the frequency and severity of menstrual-related migraines by minimizing the drop in estrogen associated with the menstrual cycle.

Using hormonal contraception to prevent menstrual-related migraines might be appropriate for women who haven’t been helped by other methods and for women who don’t have migraine with aura. Migraine with aura comes with sensory disturbances such as flashes of light, blind spots or other vision changes; tingling in your hand or face; and rarely, difficulty using language (aphasia) or weakness on one side of your body.

Women who have migraine with aura are generally advised not to use estrogen-containing contraception. If you have migraine with aura, talk to your doctor about contraception options.

Other women might develop migraines while using hormonal contraception, although the migraine might occur only in the first cycle. Talk to your doctor if that happens to you.

Tips for using hormonal contraception:

• Use a monthly birth control pill pack with fewer inactive (placebo) days.
• Eliminate the placebo days completely from most months by taking extended-cycle estrogen-progestin birth control pills (Loseasonique, Seasonique).
• Use birth control pills that have a lower dose of estrogen to reduce the drop in estrogen during the placebo days.
• Take NSAIDs and triptans during the placebo days.
• Take a low dose of estrogen pills or wear an estrogen patch during the placebo days.
• Use an estrogen-containing skin patch during the placebo days if you’re using a birth control patch.
• Take the minipill if you’re not able to take estrogen-progestin birth control pills. The minipill is a progestin-only birth control pill (Camila, Heather, others).

During pregnancy

Estrogen levels rise rapidly in early pregnancy and remain high throughout pregnancy. Migraines often improve or even disappear during pregnancy. However, tension headaches usually won’t improve, as they aren’t affected by hormone changes.

If you have chronic headaches, before you become pregnant, ask your doctor about medications and therapies that can help you during pregnancy. Many headache medications have harmful or unknown effects on a developing baby.

After delivery, an abrupt decrease in estrogen levels — along with stress, irregular eating habits and lack of sleep — might trigger headaches again.

Although you’ll need to be cautious about which headache medications you take while breastfeeding, you’ll likely have more options than you did during pregnancy. Your doctor can tell you which medications you can take.

During perimenopause and menopause

For many women who have had hormone-related headaches, migraines become more frequent and severe during perimenopause — the years leading up to menopause — because hormone levels rise and fall unevenly.

For some women, migraines improve once their menstrual periods stop, but tension headaches often get worse. If your headaches persist after menopause, you likely can continue to take your medications and use other therapies.

Hormone replacement therapy, which is sometimes used to treat perimenopause and menopause, can worsen headaches in some women, improve headaches in others or cause no changes. If you’re taking hormone replacement therapy, your doctor might recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen, which is least likely to aggravate headaches.

If hormone replacement therapy worsens your headaches, your doctor might lower the estrogen dose, change to a different form of estrogen or stop the hormone replacement therapy.

You are unique

Some women are more sensitive to the effects of hormones. If headaches are disrupting your daily activities, work or personal life, ask your doctor for help.

Dec. 10, 2020

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