When it comes to migraine attacks, every hormone can play a role. That’s because all hormones can affect brain function, Salman Azhar, MD, a neurologist at Lenox Hill Hospital in New York City, tells SELF. But in terms of migraine in cisgender women, changes in estrogen—the primary female sex hormone—is the main culprit, says Dr. Krel. Case in point: According to the Mayo Clinic, steady levels of estrogen can help ease both regular headaches and migraine attacks. However, when estrogen levels oscillate, which happens throughout a person’s life, migraine can get worse.
When are hormone fluctuations most likely to occur?
During your menstrual cycle, estrogen naturally drops right after ovulation, then again just before your period starts, says Dr. Krel. “It is during these moments, when estrogen is lowest, that some women tend to experience more frequent migraine attacks,” she says. In fact, among people with menstrual periods who have migraine, at least 60% report menstrual-related migraine attacks.
Estrogen also increases during pregnancy, potentially improving the frequency and severity of migraine attacks. But after giving birth, the hormone rapidly drops, often causing migraine to roar back with an almighty force, according to the Mayo Clinic.
And then there’s perimenopause, or the years leading up to menopause, which might start anywhere between your mid-30s to mid-50s. This time is characterized by uneven fluctuations in hormones, including—you guessed it—estrogen. Specifically, the body starts making less of the hormone, potentially causing more intense and frequent migraine attacks in some people. But once the body stops making estrogen altogether, hormone-related headaches may improve.
Bottom line: Fluctuating hormones, of any kind, can trigger migraine attacks.
Experts don’t fully understand why estrogen fluctuations can catalyze the development of migraine though.
Here are some possible explanations:
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Estrogen may affect pain neurotransmitters.
Estrogen affects the activity of certain neurotransmitters (chemical messengers released by nerve cells) involved in migraine attacks and pain. As a 2018 review article published in the Frontiers in Public Health notes, estrogen increases the production of serotonin, a neurotransmitter that regulates many biological processes.3 This includes the sensation of pain, Dr. Krel says. According to a 2022 study published in Cells, estrogen also has a protective effect against migraine—but when it fluctuates, so does serotonin, which could potentially trigger a migraine attack. Similarly, estrogen increases the release of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces pain. But again, when estrogen fluctuates, so does GABA, which may also result in migraine attacks.4
Estrogen may protect against inflammation in the brain.
Estrogen may also help protect against inflammation in the brain. Low levels of the hormone may increase this inflammation, potentially contributing to those painful migraine attacks.4 Finally, estrogen is needed for healthy relaxation of the blood vessels, including those in the brain. When estrogen rapidly drops, the blood vessels may constrict, ultimately leading to a migraine attack.1
It’s worth noting again that the high rate of migraine in cisgender women isn’t linked to the presence of estrogen itself. Instead, it’s more about the fluctuations. As Dr. Azhar points out, people assigned male at birth also have estrogen, albeit in smaller amounts. But since they don’t experience the same estrogen fluctuations, people assigned male at birth who have migraine are less likely to have hormonal triggers.
Don’t forget a migraine attack can have other triggers too.
A lot of things can trigger migraine attacks, says Dr. Azhar. “When you’re susceptible to migraine, either because of genetics or your own physiological makeup, a series of triggers can culminate into an attack.” Hormonal variations happen to be one of those triggers and an especially strong one, he says.
Source: SELF
