Hormone Replacement Therapy and Migraines: What You Need to Know

Monica Bell
8 hours ago
4 min read

Migraine headaches are a debilitating neurological condition that can wreak havoc on your life if you suffer from them. They can cause severe throbbing headaches, nausea, vomiting, and sensitivity to light and sound. Four distinct stages characterize migraines, although not everyone experiences all of them. These stages are Prodrome, Aura, Attack, and Post-Drome. A migraine can last anywhere from a few hours to several days.

Woman suffering from migraine, a common symptom during perimenopause and menopause.

What Causes or Triggers Migraines?

The causes of migraines are individual, complicated, and affected by several factors. Migraines are not fully understood but are likely caused by brain chemical imbalances.

Hormones. Women are three times more likely to have a migraine than men. A drop in estrogen during menopause, or fluctuating estrogen levels during menstrual cycles (referred to as a menstrual migraine) or perimenopause, can all cause migraines.
Genetics. Migraines tend to run in families, and if you have a close relative with migraines, you are more likely to experience them yourself.
Stress. Stress of any kind can trigger a migraine, and 50-70% of people have a significant association between stress and a migraine.
Drinks. Alcohol and too much caffeine can trigger a migraine in some people.
Sensory Stimuli. Bright or flashing lights, as well as loud sounds, can trigger migraines. Strong odors can also trigger migraines in some individuals.
Foods and Food Additives. For some, additives like MSG and processed foods can trigger migraines, as can skipping meals.
Sleep. Too much or too little sleep can cause a migraine.
Weather Changes. Changes in barometric pressure, heat, and humidity can trigger a migraine attack.

The Relationship Between Estrogen and Migraines

The relationship between estrogen and migraines is complicated. On the one hand, some women find relief from migraines with estrogen birth control pills, while others may find their migraines worsen. This could be due to individual responses to synthetic estrogen. Conversely, some women experience migraines when estrogen levels are high.

Fluctuating estrogen levels, specifically drops, are strongly linked to migraines. For women menstruating, a drop in estrogen before and during menstruation can cause migraines. The same is true of perimenopause, when estrogen levels can fluctuate wildly. Menopause is marked by a significant drop in estrogen, triggering migraines, while other women may find relief.

How Estrogen Levels Affect Migraines

Estrogen influences the opioid and serotonin system, which affects pain perception. A decline in estrogen causes reduced opioid activity, resulting in greater pain.
A lower pain threshold has been observed in women during the luteal phase (during the second part of your menstrual cycle, on about day 15 of a 28-day cycle. It ends when you get your period.)
Estrogen may also affect the vascular system, leading to changes in blood vessel function that can contribute to the development of migraines.
More recent studies have shown that calcitonin gene–related peptide (CGRP), a neuropeptide (i.e., a type of messenger molecule in the brain that works with neurotransmitters), plays a key role in migraine attacks. Since the 1980s, it has been known that severe migraine pain is related to the release of CGRP from nerve cells in the head, face, and neck (i.e., cells in the trigeminal nerve). CGRP levels fluctuate with estrogen- a drop in estrogen can lead to an increase in CGRP levels.

How to Treat Migraines and Whether to Start Hormone Replacement Therapy

If you experience migraines, you likely have a plan in place to prevent them when possible and access to effective treatment options, but here are some reminders.

Avoid Triggers

Keeping a diary of your migraines can help you pinpoint potential triggers such as food, stress, drinks, or sleep.

Get Regular Sleep

Good sleep hygiene is crucial for everyone, especially those with migraines. Establish set wake-up and bedtime times, maintain a dark and cool room, and limit screen time.

Manage Stress

Utilize relaxation techniques and engage in regular exercise.

Pain Relievers

Ibuprofen, aspirin, or Tylenol can be helpful.

Prescription Medications

Triptans, CGRP inhibitors, and other medications can prevent migraines.

Acupuncture

Acupuncture can help reduce the frequency and intensity of migraines.

Vagus Nerve Stimulation

Non-invasive stimulation of the vagus nerve can reduce the frequency of migraines.

Estrogen Replacement

Considering the significant association between estrogen decline and migraines, the logical choice, after considering any risk factors, is to try bioidentical hormone replacement therapy. You may have read that migraines with aura may increase the risk of oral contraceptive-associated strokes. However, research shows that in contrast to contraceptive doses of ethinylestradiol, migraine aura does not contraindicate the use of physiological doses of natural estrogen.

In short, delivery of consistent hormone levels through transdermal estradiol and micronized progesterone may be an effective treatment for your migraines. Additionally, you will experience all the other estrogen-related benefits, such as relief from hot flashes, improved heart and cognitive function, better bone health, a more positive mood, and relief from vaginal dryness.

If you are experiencing migraines, consider consulting with us at Optimal Hormone Health to discuss starting HRT or making adjustments to your current treatment plan to achieve long-term relief.