Why Migraines Develop and How to Overcome the Pain
If you suffer from migraines, you’re probably more aware of your hormonal fluctuations than the average woman. After all, periods of hormonal change can bring on the same pounding, blinding migraine pain that environmental triggers are known to cause, but unlike a stressful situation or smoggy day, you can’t remove yourself from the situation. Instead, you need to find a way to weather the storm until the hormonal turmoil runs its course.
Unfortunately, perimenopause can be a long, hormonally-spiked stretch of mental and physical changes, which could spell trouble for women who suffer from migraines. Recent research supports the suspicion that migraines worsen in menopause and, on the bright side, may provide some insight when it comes to treatment.
The Link Between Migraines and Menopause
There’s a close relationship between female sex hormones and migraine headaches, although some women notice it more than others. About 50% of women report that phases of their menstrual cycle have a direct and significant impact on their migraines: typically, migraines come on a day or two before their period starts. These are known as menstrual migraines.
These migraines can sometimes present as sinus pressure. Women who experience issues with the sinus and menopause may not realize it's actually a migraine, which can cause worry.
Perimenopause sinus pressure is essentially a tension headache, triggered by fluctuating estrogen levels:
- Low estrogen leads to pain. Your estrogen level plays a big role in your pain tolerance and sensitivity. When estrogen is low (for instance, right before menstruation or after menopause), pain-producing neurochemicals increase, and that may explain why migraines typically worsen during these phases.
- Stress feeds migraine symptoms. Studies have found that headaches increase by 50% to 60% once you begin perimenopause (the period leading up to menopause that can last for a decade), when estrogen and progesterone levels dip and rise, which can confuse your body and feed your stress response. The more stress you feel, the greater your risk of experiencing a migraine.
- Increase in headache severity. Once you enter menopause – that is, you haven’t had a period for 12 consecutive months – your estrogen falls permanently, which may explain why 12% of menopausal women report migraines, while only 8% of premenopausal women do. Perhaps more significantly, menopause can make migraines a whole lot worse for up to 45% of women (a lucky 15% will notice an improvement in their migraines).
While estrogen levels almost certainly impact your migraines, there might be other hormonal factors at play, too. Cyclical migraines can continue for up to five years after menopause sets in, since hormones can continue to fluctuate (albeit more mildly) after you’ve stopped menstruating, which may be enough to trigger a migraine.
But remember that your body hosts a very complex system of hormones, and it’s difficult to know which interactions could be feeding your migraine response.
Watching for Triggers
You may not be able to redirect your hormones, but there are other triggers during menopause that could be within your control. For instance, hot flashes and night sweats can disturb sleep, poor sleep encourages your body to produce more of the stress hormone cortisol, and that can have a host of consequences for your brain and nervous system.
Watching for Triggers
During perimenopause and menopause it becomes more important to watch out for typical migraine triggers, because some things that rarely bothered you before could start to team up with your hormonal fluctuations, and then you’ll have a bigger issue.
Try your best to avoid these potential migraine triggers:
- Bright light and loud noises
- Alcohol and caffeine
- Skipped meals
- Artificial sweeteners
- Foods containing tyramine (blue cheese, cured meats, soy products, and other aged or fermented foods)
Each migraine sufferer has a unique set of triggers and irritants, so you’ll have to keep an eye on any new developments in your migraine patterns to treat your symptoms more effectively. The first step is to decrease the amount of stress in your life; once you eliminate your biggest enemy, you can concentrate on building better defenses against your migraine headaches.
Revising Your Treatment Plan
Treating migraines during menopause can require a different approach than you’ve used before. You’ll have to consider your body’s needs and vulnerabilities, before you proceed with medication. However, there are some ways to reduce the frequency and severity of your migraines:
Keep a Diary
Recording details of your migraines, including the phase of your cycle, what mood you were in, and what was happening around you when the attack hit will help you track your headaches better. After keeping a journal or diary for a few months, you’re bound to see some patterns emerge, and after reporting these to your doctor, you can begin to manage your symptoms more effectively.
If you work better with structure, search online for a migraine diary template – having the fields laid out beforehand can make it easier to keep up a regular record of symptoms and triggers.
Consider Hormone Replacement Therapy
If your hormones are causing too much havoc to handle, you can talk to your doctor about hormone replacement therapy (HRT). The main concern with HRT is the increased risk of breast cancer and stroke that comes with it, but in some cases, the rewards outweigh these risks.
You’ll need to discuss with your doctor any family history of breast cancer, and whether you have any other risk factors that may interfere with the therapy. HRT patches or gels (as opposed to the oral forms) provide a more stable level of hormones, which appear to work better for migraine sufferers.
If HRT isn’t working, or happens to make your migraines worse, there are other, gentler, approaches you can take. Relaxation exercises, biofeedback and changes to your diet can have surprising effects, and regular exercise can relieve an array of menopausal symptoms (which will undoubtedly reduce your stress levels).
But be wary of adding herbal remedies to your menopause management plan – some herbs and supplements for menopause can cause more harm than good, especially if you’re taking other medication.
Migraines can interfere with your quality of life, but they shouldn’t dictate how you live your days – or how you define yourself. Menopause is a challenging time, and you owe it to yourself to counter the hormonal shift with good self-care, an open mind, and regular communication with your doctor to reduce the instance of migraine.