Are hormonal headaches and menstrual migraines the same?
Hormonal headaches, also known as menstrual migraines, are a common condition affecting up to 10% of women. These headaches are triggered by changes in hormones throughout their menstrual cycle and may be mild, moderate, or severe. At Melbourne Headache and Concussion Group, we work with women of all ages in an effort to relieve their menstrual migraines.
These headaches can be divided into two types:
- Pure menstrual migraine, which occurs exclusively during your menstrual period (typically on day one of your cycle and in at least two out of three consecutive menstrual cycles)
- Menstrual-related migraine, which typically spikes around your menstrual period but also occurs at other times of the month (typically in the middle of your cycle)
Symptoms of menstrual migraines
The main symptom of menstrual migraines is a moderate to severe headache that occurs around the onset of menstruation (or just prior) and that typically lasts for three to five days.
Other symptoms that may be experienced include:
- Pulsating or throbbing pain on one or both sides of the head
- Sensitivity to light, sound, and smell
- Nausea and/or vomiting
- Visual disturbances (known as an ‘aura’) or loss of vision
- Muscle tightness and soreness (specifically in the head, face, neck, and shoulders)
- Aching joints
- Loss of appetite
- Fatigue
- Irritability
- Dizziness and confusion
Causes of Menstrual Migraines
Menstrual migraines were typically thought to be caused by hormonal factors, specifically fluctuations in oestrogen and progesterone levels during a woman’s monthly cycle. Why, then, don’t all women experience hormonal headaches during menstruation?
Recent research suggests that a sensitised trigeminal cervical nucleus (TCN) is a primary contributing factor for hormonal migraines. Hormonal changes trigger the blood vessels in our heads to expand and contract. For some women, their TCN may incorrectly read these normal oestrogen and progesterone fluctuations as harmful, which leads to a severe headache.
How are Menstrual Migraines treated?
Although the treatment of migraines is the same regardless of their timing, it should be noted that menstrual migraines are typically less responsive than many other types of migraines. However, we’re dedicated to exploring potential avenues in an effort to help women address their pain. Some of the options that may be explored include:
- Watson Headache® Approach: This is a series of manual, non-manipulative cervical techniques that seek to decrease overstimulation of the TCN so that hormone fluctuations are no longer a trigger.
- Exercise: As stress can be a big trigger for migraines, including menstrual migraines, a relaxation exercise regimen may be beneficial in managing symptoms.
- Dry Needling: Similar to acupuncture, this technique involves inserting thin needles into specific myofascial trigger points to stimulate the muscles and release tension.
- Supplements: Some women have found that taking magnesium from the 15th day of their cycle up until menstruation starts may also be helpful.
- Medications: Taking low-dose oestrogen or progesterone (known as hormone replacement therapy) may help reduce the number of migraine days or even prevent them altogether. Non-steroidal anti-inflammatory drugs (NSAIDs), triptans, and the oral contraceptive pill may also help.
FAQ regarding menstrual/hormonal migraines
There is no specific test for these headaches. Instead, it’s recommended that you track your menstrual cycle and keep a headache diary to determine whether there’s a pattern. Your clinician will also rule out other potential causes for your pain.
Some women find that their symptoms improve with pregnancy (as oestrogen levels rise) and at the onset of menopause. This is not true for everyone, however, and perimenopause may actually cause the occurrence and duration of migraines to increase.
There are a couple of other conditions that mimic migraines and are also tied to the menstrual cycle. These include dysmenorrhea, low oestrogen (beyond normal hormonal fluctuations due to where you are in your cycle), and premenstrual dysphoric disorder (PMDD).