How Hormones Affect Migraine!

What are hormones and why do we need them?

Hormones are messengers created by glands in the Endocrine System. They control many of our bodily functions, from temperature control to much more complicated functions like reproduction and emotions. Some of the main hormone-producing glands are:

• 
• Hypothalamus
• Pancreas
• Thyroid
• Adrenal
• Pituitary
• Thalamus
• Ovaries
• Testes

Some of the hormones released by these glands to carry out, or, that have an effect on our bodily functions are:

• Prostaglandins
• Adrenaline
• Calcitonin
• Insulin
• Melatonin
• Oxytocin
• Progesterone
• Testosterone
• Thyroxine
• Vitamin D

How do Hormones affect my Migraine?

Until the age that puberty hits, boy and girls experience Migraine equally as often, however, once the hormones kick in, the ratio goes from 50:50 to 3:1 for girls. Many women experience their first migraine during their teenage years, mostly around the onset of menstruation.

Oestrogen and Progesterone are the little blighters that cause much of the trouble. They have functions that include preparing the body and uterus for pregnancy, as well as regulating the menstrual cycle. When the levels of these hormones are high everything is fine, but when, as during menstruation or during the menopause these levels drop, they can trigger a migraine attack. No one really knows why but they have theories.

Some experts theorise that there is a ‘hormonal doorway’ or portal which is affected by the change in hormonal levels. When levels of oestrogen and progesterone are high, this doorway stays closed, thereby a migraine is not triggered, however, when these hormones are low, the doorway opens and BANG! A migraine hits!!

Another theory is that falling levels of oestrogen and progesterone affect the normal working of the Central Nervous System (CNS) and the regulation of Serotonin which is a ‘feel-good’ neurotransmitter released in the brain. Some migraine sufferers are given anti-depressants because of the effect that they might have on the release of serotonin and not necessarily for their anti-depressant values.

When the body reaches a certain age, it decides that it no longer needs certain hormones, so it begins to get rid of them slowly. This dropping off can trigger migraines more often and some peri-menopausal women can suffer from terrible migraines until things level out. After the menopause, migraine attacks generally become less and less, however, there is a percentage of women who continue to suffer, and indeed whose attacks actually increase instead of abating. Again, no one is really sure why this is.

What is Menstrual Migraine?

Hormones are the big trigger in Menstrual Migraine and 60% of women who suffer from migraine notice an increased number of attacks around the time of their period. This is regarded as menstrually-related migraine. Women who suffer from this type of migraine will usually suffer from migraine at other times of the month as well.

Pure menstrual migraine is diagnosed when attacks occur exclusively around the time of your period and at no other times. It is thought that about 10% of women who suffer from migraine suffer from pure menstrual migraine. Typically it occurs on the two days before a period and the three days following the start of bleeding. Menstrual attacks tend to be less severe but can last longer. Most are not accompanied by a aura.

Again, the drop in the level of oestrogen is blamed for triggering the attack, however, another hormone called Prostaglandin – see link in previous section, which is released just before and during a period may also be a trigger in menstrual migraine. Prostaglandin is at its highest level during menstruation, especially in women who bleed heavily or suffer from particularly painful periods.

Pregnancy and Migraine 

Pregnancy for many women with migraine seems to bring some relief from migraine. Approximately 60% of them see an improvement of symptoms, especially in the second and third trimesters. The theory is that the higher and more stable levels of hormones are just about right to help keep migraines at bay, unfortunately, the migraine generally returns to its normal pattern when the baby is born.

Of those migraineurs who become pregnant, 15% actually experience worsening or new-onset migraine. This may be a result of morning (or anytime) sickness. When vomiting, you’re losing food, fluid and lowering blood sugar levels, you’re also in danger of dehydration. Many women who experience their first migraine during pregnancy will more than likely go on to suffer from the disorder for life afterwards.

Migraine itself doesn’t have any damaging effects on the baby or on the pregnancy, but any medication or treatment MUST be carefully monitored by your doctor. It’s recommended that all medication is discontinued during pregnancy as particularly the Triptans and all preventative medications are contraindicated. To date, paracetamol is the only medication considered ‘safe’ for use during pregnancy, but again must be monitored closely by a doctor. Sometimes the paracetamol can be given with an anti-emetic like Motilium which is also considered ‘safe’, but again, due to individual tolerances of different drugs, should never be taken without discussing it beforehand with a doctor. On rare occasions, a specialist MAY prescribe something a bit stronger, but only under strict supervision.

So how do you treat migraine during pregnancy if you can’t take drugs? I hear you cry in despair!

Okay, if drugs are ruled out, there are a few things which may offer relief during pregnancy including:

• Sleep/rest/retreat – Rest, sleep, retreating from the mayhem can all help you. Have some alone time (well alone with the baby bump time). Another option is to find a relaxation technique, such as yoga, mindfulness, or even sitting in a dark room listening to soft music. Whatever relaxes you and reduces stress is good. Beaumont Hospital has a mindfulness and relaxation centre, with some exercises on their website here. Again before trying anything new, speak to your doctor or gynaecologist.

• Biofeedback – This non-invasive, drug-free technique can help you to take control over some of your reactions to stress. You can learn to recognise levels of tension in certain parts of your body and then teach yourself to reduce the reaction. See www.biofeedbackireland.ie for more information

• Cold Therapy – Try using something like the Migra-Cap which you can find in some pharmacies (particularly McCabe’s) around the country. Migra-Cap combines cold therapy and complete darkness to relieve pain. It’s medication-free and very easy to use. Between uses, you leave it in your fridge or freezer.

• Light exercise – Exercise helps to balance your blood sugar levels, improves breathing and releases the feel-good endorphins, leaving you feeling much happier and healthier. Discuss with your doctor which exercise would suit you the best.

• Massage/relaxation therapy – Again, massage can help to relax you so this is good, BUT, make sure your doctor is happy that this is safe for you. Some massage therapists may refuse to treat a pregnant woman until after the first trimester. If the massage includes reflexology or aromatherapy, do double check that these will be safe as some oils may not be suitable and can be harmful to the baby. Certain conditions experienced during pregnancy can make reflexology unsuitable e.g. Continuous vomiting, Pre-Ecclampsia, DVT (Deep Vein Thrombosis). Make sure that the different therapists are trained in treating pregnant women. See Reflexology Ireland and the Irish Massage Therapists websites to find a local therapist

• Sniff green apples! – Yes, sniff green apples… Scientists at the Smell and Taste Treatment Center in Chicago found that the smell of green apples may help to lower pain

• Trigger avoidance – Again, use your migraine diary to identify and avoid your known triggers. Be aware that during pregnancy you may find additional triggers and keep an eye on them too.

• Increase in water, and snacking more frequently, especially if vomiting – As already stated above, if you suffer from a lot of sickness, this can result in low blood sugar levels and dehydration; two major triggers… try eating small, frequent meals and drinking plenty of water. If you experience nausea drink ginger ale or ginger tea

Homeopathic or herbal remedies (Feverfew) have side effects which may be harmful to the baby and so should be avoided as much as possible when pregnant, especially during the first three months, but discuss everything with your doctor.

Menopause and Migraine

Hormones! They’re necessary for life, but they’re a burden!! Their effects on us women are as varied as they are torturous, and rarely more so than when we’re at the stage where we’re running out of them. Floating in the Irish Sea on a November evening can be quite an appealing idea when those hot flushes hit!! The havoc they play with our bodies affects how migraine hits too. Many women coming up to, and during the menopause find that their migraines get a lot worse, in both frequency and intensity and continue to do so until, in most cases, the hormones level off and the migraines subside. Many women find that after this happens, they are rarely if ever, bothered by migraine again. Unfortunately some women – those who suffer exclusively from Menstrual Migraine – do continue to experience regular migraine attacks and in the rare case, they can even get worse!

So what is the Menopause?

The dictionary definition is:
menopause
noun

1. the ceasing of menstruation.
   • the period in a woman’s life (typically between the ages of 45 and 50) when menstruation ceases.

The word ‘Menopause’ comes from ancient Greek – Meno/Mene= Month and Pauein= to stop. English got words such as menstruate (Late Middle English) and menopause (late 19th century) from these. Mene may also be an ancient word for the moon which would correspond with the month as that is the length of time it takes for the moon to orbit the earth!

Now for the science part!! – sort of!

In your late thirties, your body begins to produce fewer eggs to fertilise and as a result the necessary hormones change. Over time, your periods become more and more irregular, and your symptoms change. You may have shorter periods or heavier bleeding.

About 6 months to a year before your period stops for good, your oestrogen levels begin to drop, and when they drop low enough, your period stops completely. This is also when the migraines can become worse.  You are regarded as being menopausal when you’ve had a year of no periods.

During the next year, your oestrogen levels continue to decrease, which happily lowers your risk of certain types of cancer, but it can cause other problems, like

• Bone loss – increasing your risk of Osteoporosis
• Skin – decreasing your collagen levels
• Tooth – increasing your risk of tooth loss and decay
• Heart disease – Increasing your risk of heart problem, although why is unknown.

When you reach this stage, your oestrogen levels stabilise and most women experience fewer and fewer migraines.

For some women however, the menopause can make their migraine worse, or can even trigger them for the first time! No one knows why, but it is thought that there may be a link to Hormone Replacement Therapy (HRT) given to some women. HRT is no longer generally recommended for menopausal women. The Mirena Coil is however recommended due to its slow, low-dosage release of the hormone progesterone.

How do I treat Hormonal Migraine

Hormonal migraine can be treated much like most other migraines. The first thing to do is to establish the pattern and the fact that it is hormonally linked. To do this you can use a migraine diary which you can get from us, or download from our website. If you do establish that you suffer from pure menstrual migraine, then you could be one of the luckier ones. If your cycle is regular, then you know exactly when you will get a migraine and for how long. Always carry your acute medication with you e.g. triptans, NSAIDs, painkillers, etc. The earlier in the attack you take them, the better they will work. Speak to your doctor about your options. There may be a medication which works more slowly but keeps the migraine at bay a bit longer during the whole period.

If you have two or more attacks a month, you may benefit from some preventative measures. Sometimes, the dosage of your medication can be increased around the time of your period to provide defence against further attacks. Medication that might help include:

• Analgesics – paracetamol, aspirin, NSAIDs like ibuprofen although there is an increased risk of medication overuse headache with these medications so monitor your intake carefully, especially if any of them contain codeine.
• Triptans – there are 6 Triptans available in Ireland and these target serotonin receptors in the brain as well as killing the pain. Triptans are fast-acting and are successful in up to 80% of cases. You and your doctor should be able to find the right one for you, and which format will suit you. Some triptans come in injection form, nasal spray and some melt on the tongue. These forms enter your system more quickly and get to work faster. They are not prescribed for children, pregnant women or people over 65 generally.
• Preventative – Beta-blockers, tricyclic anti-depressants and some epilepsy medication may help as preventative medications.They are usually prescribed for people who have several attacks a month or have established a regular pattern. They can be taken for a period of between 6 & 12 months

Some non-medication methods may help either alone, as in cases of pregnancy, or to complement the medication, such as;

• Sleep/Rest
• Biofeedback
• Yoga
• Lifestyle management
• Acupuncture
• Massage/Relaxation
• Trigger Avoidance and management if it’s more than hormonal migraine
• Drinking water
• Warm/Cold therapy, depending on which one suits you best.

Some supplements can help lessen the effects of Pre-Menstrual Syndrome (PMS):

• Vitamin B6 – Mood enhancer
• Magnesium – helps with bloating and breast tenderness
• Evening Primrose Oil – helps with breast tenderness

These and other supplements may have a positive effect on your migraines too, but be sure to speak to your GP about them, as some supplements and medications do not mix and can be dangerous if taken together.

Migraine and Contraception

Hormonal contraception, such as pills, patches, rings, injectable forms are all regarded as safe for most women who use it. This also includes women with migraine, however, the effect of the contraceptive pill on migraine varies quite a bit and can be unpredictable. The Combined Oral Contraceptive (COC) is contraindicated in women who suffer from migraine with aura. It places such women in an increased risk of stroke. As a result, the progesterone only Oral Contraceptive Pill (OCP) is the pill of choice for women who suffer from migraine.

The risk of stroke in women younger than 50 is very low, however it is advised that women who suffer from migraine with aura use the lowest possible oestrogen dose and keep away from other risk factors such as smoking if possible.

If you think that there is a possibility that your pill itself may be a factor in triggering your migraine, talk to your doctor. Keep an eye on patterns and watch for change. If your migraines change for the worse, or you experience an aura for the  first time, then you should stop taking the pill and see your GP as soon as possible.