Period headaches and menstrual migraines: Are my hormones hurting my head?
AUGUST 3, 2021
As if getting our period isn’t a headache enough, this week we’re taking a deep-dive into hormonally influenced head pains. Read on to learn the difference between a period headache and a menstrual migraine, and how you can track and treat your head splitting symptoms
Headaches and migraines aren’t the same, and each have distinct clinical characteristics
Both headaches and migraines are far more common in women than in men (1) and over 50% of women report their head pains to be ‘menstrually related’ (2)
Fluctuations in female sex hormones, especially estrogen, is thought to be one of the main triggers and causes of both period headaches and menstrual migraines (3)
Hormonal birth control can help to relieve symptoms of menstrually related headaches or migraines
But everyone's case is different, so getting a hormonal birth control that is in tune with your body and hormones, on the correct regimen, is super important
It would be pretty darn hard to find someone with a cycle who isn’t well acquainted with at least one pre-period hormonal hang-up.
Most of us are fairly pally with the better-known nemeses (cramps, spots and mood drops), but there’s a lesser-known, but certainly not less severe (for some) PMS symptom that lurks in the latter half of our menstrual cycles—headaches.
Period headaches and menstrual migraines are pretty common occurrences for many of us—more than 50% of women who experience migraines report them to be ‘menstrually related’(2).
What’s more, there’s a distinct sex split when it comes to who’s more likely to suffer from a cranky cranium.
People with periods are 2-3 times more likely than those without to experience headaches or migraines in general (1) (cue the ‘ah-ha, maybe it’s my hormones’ moment).
But why do our cycles mean we’re more likely to be struck down with a splitting headache?
Can our hormones cause headaches and is that migraine really linked to our menstrual cycles?
Let’s take 5, and find out...
Headaches vs. migraines: What’s the difference?
First things first, let's get the definitions done. Anyone who’s experienced a migraine will be able to tell you categorically, ‘no, it’s definitely not just a headache'.
Although both can be seriously head frying, headaches and migraines aren’t the same. Both have distinct clinical characteristics, with migraines falling on the far more severe side of your average ear split.
Headaches are usually characterized by a mild to severe pain, pressure or ache felt in the forehead, temples, face or crown of the head (4).
Typical headache types include:
Unilateral headaches: pain across just one side of the head or face (typical of a migraine headache) (5)
Tension headaches: tightness or pain around the forehead
Cluster headaches: severe pain felt as stabbing or burning sensations around the eye socket areas
Sinus headaches: pain around the sinuses
Migraines are most often unilateral (5) and characterized by very intense pulsing and throbbing pains (6). Usually migraines are gradual in onset, increasing in intensity over a period of hours before climaxing at a grand crescendo that may last anywhere between 4-72 hours (6).
25% of people that suffer from migraines will experience them with what’s known as ‘auras’ (7). This somewhat supernatural sounding term refers to a series of sensory symptoms that can accompany migraines, including:
Nausea or vomiting (7)
Pain behind the ears (7)
Changes to sense of smell, taste or touch—such as increased sensitivity to lights or sound, seeing flashes or spots or even temporary loss of vision (7).
Aura migraine attacks are usually episodic, with symptoms coming and going over a prolonged period, in phases (6).
So can hormones cause headaches?
You betcha. There’s a strong link between headaches and the balance of our fluctuating female sex hormones, especially estrogen (3).
Hormonally influenced headaches are triggered when our estrogen levels take a nose-dive after ovulation (in what’s known as the luteal phase) and then again just before our periods, or throughout (8).
For a headache to be hormonally influenced, it usually has to occur anywhere in the two weeks running up to our periods, or during our periods, (9) (basically, whenever our estrogen is ebbing).
What about menstrual migraines—are they hormonal too?
Dipping estrogen is also believed to be the main trigger for migraines in women and people with cycles (10).
For it to be ‘menstrual’, a migraine needs to kick in 2 days before the start of your period and end around the 3rd day of your bleed (9). Some people with cycles do experience migraines mid-cycle, but this is less common and they tend to be less severe (11).
Interestingly, on the flip side, estrogen dominance (having too much estrogen in relation to progesterone), or chronically high levels of estrogen, are thought to be the main triggers for migraines with auras (10).
Our estrogen levels become increasingly erratic during perimenopause (the lead up to menopause) and this can trigger many people with cycles to start experiencing particularly potent period headaches or menstrual migraines during this time (3,10).
The estrogen-serotonin relationship
So it seems that our estrogen levels have a heavy hand in our propensity for head pain—but why? Current research suggests that estrogen's best pal, serotonin, may also be involved.
Estrogen has an intimate relationship with serotonin (a neurotransmitter that regulates pain and mood) (12). When our estrogen levels vary, so do our serotonin levels (12,13) which may also be a factor in triggering our period headaches or menstrual migraines (13).
Everyone’s case will be different, but if you’re experiencing cyclical migraines or headaches, it’s likely that your estrogen levels, and possibly serotonin levels, are to blame.
Track and treat: Headaches and hormonal birth control
If you’re looking for treatment for hormone headaches the first step would always be to decipher that it’s definitely your hormones that are triggering your symptoms.
You can do this by tracking your cycle and noting on which days your headaches are occurring. If they’re coming in like clockwork during the last two weeks of your cycle or during your period, ebbing estrogen probably has something to do with it (9).
If you are really suffering from period headaches or menstrual migraines, you may also find relief with an unlikely source—hormonal birth control (14).
Birth control pills, when taken on a continuous regimen, help to stabilize our female sex hormone levels by keeping them at a consistent level, rather than the ups and downs of our usual natural flows (15,16). This decrease in estrogen drop-off can help reduce the frequency or severity of period headaches and menstrual migraines (15,16).
If you suffer from migraines with auras, combined pills (COCs) probably aren’t safe for you (14,17) and may actually make your symptoms worse. But the good news is progestin-only (POPs or the mini-pill), or even non-hormonal birth control, could really help (17).
Birth control pills come in allllll kinds of different shapes and sizes, so finding one that’s right for you and your particular symptoms is super important—especially as taking hormonal birth control can actually trigger migraines and headaches in some people (17).
At Tuune, we can recommend birth control options that are best suited to your particular symptoms. By taking into consideration your medical history, previous experiences on birth control (if any), your hormones, mental health and opinions, we can help you find your perfect fit.
Finding the right birth control for you doesn’t need to be the (sometimes literal) headache, it historically has been.
Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017 Jan;16(1):76–87.
MacGregor EA. Menstrual migraine: a clinical review. BMJ Sex Reprod Health. 2007 Jan 1;33(1):36–47.
Chai NC, Peterlin BL, Calhoun AH. Migraine and estrogen. Curr Opin Neurol. 2014 Jun;27(3):315–24.
Steiner TJ, Fontebasso M. Headache. BMJ. 2002 Oct 19;325(7369):881–6.
Obermann M, Katsarava Z. Epidemiology of unilateral headaches. Expert Rev Neurother. 2008 Sep;8(9):1313–20.
Pescador Ruschel MA, De Jesus O. Migraine Headache. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Jun 28]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560787/
Shankar Kikkeri N, Nagalli S. Migraine with Aura. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Jun 28]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK554611/
Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Jun 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK500020/
Hormone headaches [Internet]. nhs.uk. 2018 [cited 2021 Jul 8]. Available from: https://www.nhs.uk/conditions/hormone-headaches/
MacGregor EA. Migraine, menopause and hormone replacement therapy. Post Reprod Health. 2018 Mar;24(1):11–8.
Kiesner J, Martin VT. Mid-Cycle Headaches and Their Relationship to Different Patterns of Premenstrual Stress Symptoms. Headache J Head Face Pain. 2013;53(6):935–46.
Del Río JP, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P. Steroid Hormones and Their Action in Women's Brains: The Importance of Hormonal Balance. Front Public Health. 2018;6:141. Published 2018 May 23.
Aggarwal M, Puri V, Puri S. Serotonin and CGRP in Migraine. Ann Neurosci. 2012 Apr;19(2):88–94.
Edlow AG, Bartz D. Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence. Rev Obstet Gynecol. 2010;3(2):55–65.
Coffee AL, Sulak PJ, Hill AJ, Hansen DJ, Kuehl TJ, Clark JW. Extended cycle combined oral contraceptives and prophylactic frovatriptan during the hormone-free interval in women with menstrual-related migraines. J Womens Health 2002. 2014 Apr;23(4):310–7.
Sulak P, Willis S, Kuehl T, Coffee A, Clark J. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache. 2007 Jan;47(1):27–37.
Nappi RE, Merki-Feld GS, Terreno E, Pellegrinelli A, Viana M. Hormonal contraception in women with migraine: is progestogen-only contraception a better choice? J Headache Pain. 2013;14(1):66.
Annalisa Hayes (she/her)
Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.
Medically reviewed by
Dr. Arushee Prasad, GP, MBBS (she/her)
Dr Arushee Prasad is a GP for NHS England with an MBBS in Medicine and Surgery, and an MRCGP from the Royal College of General Practitioners. Passionate about digital health and algorithmic medicine, Arushee was previously an Algorithmic Medical Doctor for Docly.
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