Hormones have an impact on migraine in women. Many women find their migraine symptoms are affected by menstruation, hormonal contraception, pregnancy, and menopause.

Menstrual Migraine

Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after your period begins. It’s usually more severe and more difficult to treat than other types of migraine. 7-19% of women get menstrual migraine. The vast majority of these women also have migraine at other times of the month, too.

In the same woman, attacks of menstrual migraine may differ from their other attacks in duration, severity, symptoms, and response to treatment. Estrogen itself is not the culprit. Hormonal fluctuations, and especially estrogen withdrawal, are thought to trigger the attack.

Menstrual migraine is generally treated with the same medications that are used for other types of migraine. If a woman’s menstrual migraine is so severe that it doesn’t respond to these medications, hormonal contraceptives might be considered as a treatment.

Hormonal Contraception

While birth control pills remain the most popular form of hormonal contraception, hormones can also be administered vaginally, by patch, or injection. The impact of hormonal contraception on migraine varies from woman to woman. Some find they have fewer headaches, while others experience more pain, and some find there’s no effect at all.

Oral contraceptives can trigger a woman’s first migraine attack, especially if she has a family history of migraine. Contraceptives which reduce or eliminate periods are sometimes used to treat severe menstrual migraine. Women with migraine should be careful when choosing a hormonal contraceptive, and weigh the risks and benefits of a particular contraceptive with their doctor.

Pregnancy and Nursing

Migraine sufferers should discuss their pregnancy plans with their doctors. Some migraine medications may impact the ability to conceive and may harm the fetus.

60% of pregnant sufferers find their migraines improve significantly in their first trimester, and more than 75% find they improve or even disappear during the rest of their pregnancy. Unfortunately, this is not the case for everyone. 15% report their migraines worsen during the first trimester, and about 25% notice no change. Usually, sufferers return to their pre-pregnancy migraine patterns after they give birth. Regular nursing may delay the return of migraines.

Menopause

Migraines often worsen during perimenopause, the years before menopause, with intense hormonal fluctuations. But the prevalence of migraine decreases significantly during menopause, when menstruation ends and hormones cease fluctuating. Migraines improve or go away entirely in 67% of sufferers. Women who go through natural menopause often find their migraine symptoms improve dramatically, while women who experience a surgical menopause often suffer more. The effect of estrogen replacement therapy on migraine varies.

Later Life

The prevalence of migraine drops markedly after age 60 to 7.5% in older women. Few sufferers have their first migraine after age 65. It’s important to consult a doctor to explore the causes of headaches in later life to rule out other medical problems.