Headaches and hormones: What's the connection?

Many things can contribute to headaches, including family history and age. But women often notice a link between headaches and hormonal changes.

The hormones estrogen (ES-truh-jen) and progesterone (pro-JES-tuh-rohn) play key roles in the menstrual cycle and pregnancy. Hormones also may affect headache-related chemicals in the brain.

Having steady estrogen levels can improve headaches. But drops or changes in estrogen levels can make headaches worse.

However, you're not completely at the mercy of your hormones. Your health care provider can help you treat or prevent hormone-related headaches.

During your period

The drop in estrogen just before your period may cause headaches. Many people with migraines report that they have migraines before or during menstruation.

You can turn to proven treatments for migraines related to hormone changes. These treatments 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. Learning these exercises can help lower stress. Stress can be a trigger for headaches.
• Biofeedback. Biofeedback helps you monitor how your body responds to stress. It has been shown to help some people with migraines.
• Acupuncture. Acupuncture may improve your headaches and help you relax.
• Nonprescription pain relievers. Your health care provider may recommend that you take a nonsteroidal anti-inflammatory drug (NSAID), such as naproxen sodium (Aleve) or ibuprofen (Advil, Motrin IB, others). These medicines may relieve your pain soon after your headache begins.
• Triptans. These medicines block pain signals in your brain. Triptans often relieve headache pain within two hours. They also help control vomiting.
• Anti-nausea medicines. Your health care provider may recommend medicines to treat nausea and vomiting for migraines. The medicines may include prochlorperazine (Compro, Procomp) and promethazine (Promethazine Plain, Promethegan).
• Gepants. Calcitonin gene-related peptide antagonists, known as gepants, is a newer group of medicines for treating migraine.
• Other prescription pain medicines. Sometimes your health care provider may suggest other prescription pain medicines such as dihydroergotamine (Trudhesa, Migranal). These can't be used with triptans.

Preventive treatment

If you have several severe headaches a month, your health care provider may recommend preventing them by taking NSAIDs or triptans.

If your menstrual cycle is regular, it may be most effective to take a headache medicine a few days before your period. Then continue taking it during your period.

If you have migraines throughout the month, your health care provider may recommend that you take medicines every day. Your provider also might recommend taking medicines daily if your periods aren't regular.

Daily medicines might include beta blockers, anticonvulsants, calcium channel blockers, antidepressants or magnesium.

Your health care provider also might consider monthly injections of a calcitonin gene-related peptide monoclonal antibody. The injections may help prevent headaches, especially if other medicines haven't worked.

Your provider will likely review any other medical conditions you have to decide which medicines may be most appropriate.

Lifestyle changes also may help you have fewer headaches. Or they may shorten the headaches or help make them less severe. Lifestyle changes include reducing stress, not skipping meals and exercising regularly.

Hormonal birth control use

Hormonal contraception can change headache patterns. It can improve headaches in some people but make them worse in others. Hormonal contraceptives include birth control pills, patches or vaginal rings.

Birth control may help relieve headaches by minimizing the drop in estrogen that happens during a period. You may have fewer migraines. Or your migraines may be less severe.

Using hormonal birth control to prevent migraines may be appropriate if you don't smoke and if you don't have migraine with aura. But if you smoke or experience aura, discuss this with your health care provider before starting birth control that contains estrogen.

Migraine with aura means having nervous system symptoms before or during a migraine. You might see flashes of light or notice blind spots in your vision. Or you may have other vision changes. You might feel tingling in your hands or face. Rarely, migraine with aura can cause trouble speaking or using language. In rare cases it can cause weakness on one side of the body. If you have migraine with aura, talk to your health care provider. If you have new spells of visual changes, sensory changes, weakness or trouble speaking without a migraine, seek medical care right away. This is true especially if you haven’t experienced these symptoms before.

If you have a history of migraine with aura, it's important that you don't take estrogen if you smoke. Smoking while taking birth control that contains estrogen puts you at higher risk of having a stroke.

While birth control can help relieve headaches for some, it may trigger headaches for others. But headaches might only occur during the first month of taking birth control. Talk to your health care provider if this happens to you.

If birth control seems to cause your headaches, your health care provider might recommend:

• Using a monthly birth control pill pack with fewer placebos. Placebos are pills that don't contain hormones.
• Stopping the placebo days completely for most months. This can be done by taking extended-cycle estrogen-progestin birth control pills (Loseasonique, Seasonique).
• Using birth control pills that have a lower dose of estrogen. This helps reduce the drop in estrogen during the placebo days.
• Taking NSAIDs and triptans during the placebo days.
• Taking a low dose of estrogen pills or wearing an estrogen patch during the placebo days.
• Adjusting your use of a birth control patch. If you use a birth control patch during three weeks of the month, use a skin patch that contains estrogen on the fourth week.
• Taking the minipill. If you're not able to take estrogen-progestin birth control pills, the minipill norethindrone (Camila, Heather, others) contains progestin but not estrogen.

During pregnancy

Migraines often improve or even stop during pregnancy. This may be because estrogen levels rise quickly in early pregnancy and stay high throughout pregnancy. However, tension headaches usually won't improve, as they aren't affected by hormone changes.

If you have regular headaches, it's important to talk to your health care provider about medicines that are safe during pregnancy. Have this conversation before getting pregnant. Many headache medicines have harmful or unknown effects on a developing baby.

If your headaches go away during pregnancy, they might return after delivery. This is because of the sudden drop in estrogen levels that happens after giving birth. It may also be due to stress, a change in eating habits and lack of sleep.

If headaches return while you're breastfeeding, talk to your health care provider about which medicines are safe to take.

During perimenopause and menopause

Hormone-related migraines may become more frequent and severe during the years leading up to the last period, known as perimenopause. This is because hormone levels rise and fall as you approach your last period. You've reached menopause once you don't get any more periods.

For some people, migraines improve once periods stop. But tension headaches often get worse. If your headaches continue, you likely can stay on your medicines or use other therapies.

Hormone replacement therapy (HRT) is sometimes used to treat perimenopause and menopause. HRT may worsen headaches in some people, and it may improve headaches in others. Or it may cause no changes. If you're taking HRT, your health care provider might recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen.

If HRT makes your headaches worse, your health care provider might lower the estrogen dose. Or your provider might recommend a different form of estrogen or to stop the hormone replacement therapy.

Also talk to your health care provider if you're considering taking HRT and you smoke.

You are unique

Some people are more sensitive to the effects of hormones. If headaches are affecting your daily activities, work or personal life, ask your health care provider for help.