June is Migraine and Headache Awareness Month-Can Estrogen Help?
Written by Kathy Lynch, PharmD – Women’s International Pharmacy
Forty percent of women and 20% of men experience migraine headaches in their lifetime. Up to 60% of female migraine sufferers have headaches associated with menstruation. According to the International Headache Society, menstrual migraines without aura (a pre-headache visual, sensory, motor or verbal disturbance) can begin two days before to three days after bleeding starts.
Possible triggers include a decrease in estradiol, release of inflammatory substances from the uterine lining, low magnesium, decreases in certain brain chemicals like serotonin and GABA, dehydration, suspected foods and insufficient sleep. Some migraine specialists believe that a decrease in estradiol levels is the most likely trigger.
According to Dr. E. Anne MacGregor, raising premenstrual estradiol levels can help to avert or minimize the effect of these migraines. Maintaining estrogen in a range of 45-75 pg/ml may reduce the intensity and frequency of migraine headaches. Estradiol 1.5mg gel, applied six days prior to bleeding and continued through day 2 of menses, has been shown to effectively decrease the number of migraine days in some women. Extending this time period beyond day 2 and tapering the dose may help prevent “withdrawal” headaches caused by stopping estradiol abruptly. Progesterone may also help decrease these headaches because progesterone helps regulate pain and pain perception through GABA receptors in the brain.
- MacGregor EA. Menstrual Migraine: Therapeutic Approaches. Ther Adv Neurol Disord. 2009 Sep;2(5):327-36. doi: 10.1177/1756285609335537.
- Bellanger RA. Migraine in Women: The Role of Hormones. US Pharm. 2012; 37(9): 29-32.
- Martin VT. Menstrual Migraine: New Approaches to Diagnosis and Treatment. American Headache Society. https://americanheadachesociety.org/wp-content/uploads/2016/07/Vincent_Martin_-_Menstrual_Martin.pdf