Gillian Goddard

7 min Read Gillian Goddard

Gillian Goddard

Handling Hormonal Headaches

Understanding why women are plagued with migraines

Gillian Goddard

7 min Read

A few years ago, I started to get some nasty headaches. They would be present when I woke in the morning and only subsided with a vat of coffee and a fistful of ibuprofen — not something I would recommend to others. At first I thought stress was triggering them. I was trying to care for patients during a global pandemic while my kids were on Zoom, their learning screeching to a halt. But even after the darkest days of 2020 passed, the headaches did not. 

I did what I tell my patients to do and started to track my headaches in my planner. A pattern quickly emerged: the headaches were always on the second day of my period or related to changes in the weather. Once I knew that, I could manage them better. Then, a couple of months ago, the pattern changed and I had six headaches in one month. Something had to be done!

person having headache
Claudia Barbosa / Pexels

I know I am not alone. Women are three times as likely as men to suffer from migraine headaches. By their early 50s, more than 40% of women will experience migraines. There are certain times during our reproductive lives when we are more likely to experience headaches — during puberty, early pregnancy, postpartum, and the perimenopausal transition. 

Today we will mostly be talking about migraine headaches — moderate to severe throbbing or pulsing pain on one side of the head. While hormonal changes can trigger all kinds of headaches, migraine headaches are the best studied. If you are suffering from recurrent headaches that require more than an over-the-counter medication to treat effectively, you should discuss your symptoms with your doctor. Too many women grin and bear it when it comes to headaches.  

Why do women get headaches?

You won’t be surprised to hear that estrogen plays a big role here. Since the 1970s, we have known estrogen has significant effects in the brain. When estrogen levels are high, our brain is less sensitive to pain; this seems to lead to less inflammation in the blood vessels in our brain. When estrogen levels are dropping, our brain is more sensitive to pain, which triggers the release of inflammatory substances in the blood vessels of the brain, leading to headaches. 

This means that anytime estrogen levels are dropping, headaches can occur. For most women, headaches will occur in the two days leading up to their menstrual period through the first three days of their period. Some women may also have headaches around ovulation, though this is less common. 

Dropping estrogen also explains why women can have headaches in the early postpartum period. Estrogen levels in pregnancy are very elevated. After delivery, estrogen levels plummet to prepregnancy levels in just five days. 

But what about during pregnancy? In fact, for 50% to 80% of women, headaches decrease during the second and third trimester of pregnancy. Some women experience a complete remission of migraines. This makes sense, because estrogen levels are stable and high in pregnancy. 

There are a subset of women, particularly women with a history of migraine with aura (see below about aura), who note worsening migraines in the first trimester. There are also a small number of women who will experience new-onset migraines in pregnancy, usually accompanied by aura. 

Hormonal headaches can occur at any age, but I did not have them before my 40s. It turns out I am not unusual. Many women first experience hormonal migraines in the late-reproductive stage. During this time, our estrogen levels rise higher and drop lower over the course of our regular menstrual cycles. These more dramatic fluctuations in estrogen are the perfect trigger for new headaches. 

Many women continue to experience an increase in headache frequency through perimenopause and early menopause. The good news is that after the earliest part of menopause, most women have complete resolution of their hormonally triggered migraines. This is because after the first year or so of menopause, estrogen levels typically remain stably low.

What is aura and why does it matter?

When talking with you about headaches, your doctor will likely ask if you have aura. Aura is a sensory disturbance that occurs just before or during a migraine headache. It is often visual — flashing lights or blind spots — but can include tingling or weakness or auditory disturbance such as ringing in the ears. Most women who experience menstrual migraines do not experience aura, even if they have migraines with aura at other times. 

Women who experience migraines are at increased risk of stroke — though the baseline risk of stroke in young women is exceedingly low, about 11 to 21 per 100,000 women. Having aura further increases that risk about two-fold — still a very small number of women. 

For some women, birth control pills may offer relief from migraine headaches. The stable dose of estrogen in birth control pills can prevent migraines. However, migraine with aura has long been considered a contraindication to using birth control pills because birth control pills are thought to further increase stroke risk. 

The studies of stroke risk in women with migraine with aura on birth control pills were performed many years ago using high-dose birth control pills that are not typically prescribed today. Prescribing birth control pills to women with migraines with aura remains controversial. This controversy does not necessarily extend to hormone replacement therapy, because estrogen doses are typically even lower. 

Can hormonal headaches be prevented?

The first action you can take to reduce headache frequency is to look for triggers in addition to your menstrual cycle that may bring on headaches. Inadequate sleep, dehydration, and alcohol consumption are common triggers. Avoiding triggers even just around your period may reduce headache frequency.

Some supplements have been shown to reduce headache frequency. Magnesium and riboflavin have both been shown to reduce menstrual migraines. I found relief from my menstrual headaches for many years taking a daily magnesium supplement. 

For many women, birth control pills and hormone replacement therapy can reduce headache frequency. Some women will still get headaches while taking the sugar pills in their birth control pack. If that is the case for you, you may want to consider taking your birth control pills continuously — skipping the sugar pills altogether. 

In some women, taking birth control pills can trigger migraine headaches. It may be possible to switch pill formulations and reduce headache frequency, so definitely talk to your doctor. In a few cases, stopping birth control pills may be the best option.

For those who cannot take estrogen — or prefer not to — there are a number of non-hormonal medications that have been shown to decrease the frequency of hormonal migraines. In some cases, medications may be taken only around the time of your period; for other women, taking preventative medications all the time may yield the best results. It is important to work with your doctor, or even a neurologist who specializes in headache management, to find the right option for you. 

The bottom line

  • Hormonal headaches are very common and are triggered by dropping estrogen levels.
  • The severity and frequency of headaches can be worse around puberty, in the postpartum period, and during the perimenopausal transition. 
  • Lifestyle changes, supplements like magnesium and riboflavin, estrogen in the form of birth control pills or hormone replacement therapy, and non-hormonal medications can all reduce the frequency and severity of symptoms. 
2 Comments
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Kayla
21 days ago

I have experienced hormonal migraines and migraines with aura since age 22 and I’m now 35. The only periods when I haven’t experienced ANY migraine headaches were during both of my pregnancies and before my period returned (such a relief!). Like most people who suffer from migraines, I’ve done a lot of reading on the topic and have started honing in on each potential trigger to reduce the frequency of migraines during ovulation and the first day of my period, but I haven’t been successful yet. Thank you for sharing the suggestion of magnesium and riboflavin supplements–will definitely give them a try (and, will note that both supplements are ingredients in prenatal vitamins). Glad to hear that you’ve been able to manage your own migraine attacks and I’m hopeful that I will get to a similar place before perimenopause.

Arielle
Arielle
23 days ago

I have been trying to figure out why I am getting more headaches suddenly and this all aligns. What a great gift in my in-box this morning. Thank you!!

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Gillian Goddard

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Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic. 

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents. 

Share this post with a friend who could use a little more data, and a little less parenting overwhelm. 

📷 Me and my oldest, collaborating on “Expecting Better”

Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic.

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents.

Share this post with a friend who could use a little more data, and a little less parenting overwhelm.

📷 Me and my oldest, collaborating on “Expecting Better”
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#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles
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🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships

Dr. Gillian Goddard sums up what she learned from the Hot Flash S e x Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

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Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy.

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety
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Prevention is key! I suggest:
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