Headaches and hormones: What's the connection?

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Headaches and hormones: What's the connection?

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 and progesterone — which play key roles in regulating the menstrual cycle and pregnancy — may affect headache-related chemicals in the brain. Higher estrogen levels may improve headaches, while lower estrogen levels can make headaches worse.

Though fluctuating hormone levels can influence headache patterns, you're not totally at the mercy of your hormones. Your doctor can help you treat — or prevent — headaches.

During menstruation

The drop in estrogen just before your period may contribute to headaches. Headaches are a common symptom of premenstrual syndrome, and many women with migraines report headaches before or during menstruation. You can treat menstrual-related migraines by:

  • Applying 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.
  • Massaging the muscles. Massage tight, tender muscles in the back of the head, neck and shoulders.
  • Taking over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, others) and ibuprofen (Advil, Motrin, others).
  • Taking prescription pain medication can help if over-the-counter medications and lifestyle changes don't.

If you have three or more debilitating headaches a month, your doctor may recommend preventive treatment with either over-the-counter or prescription pain medications. If your menstrual cycle is regular, it's often most effective to take preventive headache medication starting a few days before your period and continuing through the first few days of your period. If you have migraines throughout your menstrual cycle or your periods are irregular, it may be better to take preventive medication every day.

Using birth control pills

Some women experience headaches for the first time after starting birth control pills or other hormonal methods of birth control. For others, hormonal birth control changes existing headache patterns — sometimes for the better, sometimes for the worse.

If your method of birth control seems to trigger headaches or make them worse, consult your doctor. Sometimes it helps to use:

  • A monthly pill pack with fewer inactive (placebo) days or to eliminate the placebo days completely from most cycles
  • An estrogen-containing skin patch during the placebo week of the birth control pill
  • A progestin-only birth control pill or another type of contraception

During pregnancy

Estrogen levels rise rapidly in early pregnancy and remain high throughout pregnancy. Migraines often improve or even disappear during pregnancy, but tension headaches are less likely to improve. After delivery, an abrupt decrease in estrogen levels — along with stress, irregular eating habits and lack of sleep — may trigger headaches again.

If you have headaches during pregnancy, ask your doctor about treatment options. Many headache medications may have harmful or unknown effects on a developing baby, especially if you take them at the time of conception. Although you'll need to be cautious about headache medications while you're breast-feeding, you'll have more options than you did during pregnancy.

During perimenopause and menopause

For many women, migraines become more frequent and severe during perimenopause — the years leading up to menopause — because hormone levels rise and fall unevenly. This fluctuation can trigger migraines.

For most women, migraines improve once their menstrual periods cease — but tension headaches often get worse. Hormone therapy can affect headaches, too. Menopausal hormone therapy worsens headaches in some women and improves headaches in others.

If your headaches persist after menopause, you can continue to use the same medication and lifestyle measures as always. If you choose to use estrogen to manage the signs and symptoms of menopause, your doctor may recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen, which is least likely to aggravate headaches.

Every woman is 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. Treatment is available.

Last Updated: 2010-05-29
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