Hormone Headaches: What Causes Them and How to Get Relief (video/podcast)

Hormones affect so many aspects of our health, including our moods, hunger, sleep, energy and much more. For women, fluctuating hormone levels can cause headaches that range from annoying to debilitating.

Why do hormone headaches happen and how can women find relief? In this video, San Diego Health host Susan Taylor talks about hormone headaches with Emily Engel, MD, a neurologist and director of the Dalessio Headache Center at Scripps Clinic.

According to Dr. Engel, a hormone headache is almost always a migraine. Hormonal changes are a major trigger for migraine and the brain is very sensitive to even subtle hormonal changes.

While a disruptive headache is the most common symptom of a migraine, patients often will have other symptoms, such as sensitivity to light or sound, nausea or vomiting. Some patients will feel dizzy, but the dizziness may occur separately from the headache.

Additionally, patients often crave sweets, especially chocolate, just as the migraine starts and usually before the pain begins. Dr. Engel says this created the myth that chocolate triggers migraine.

While sweets can’t cause migraine, hormone changes are another story. During menstruation, estrogen levels drop, so it makes sense that women develop hormonal headache symptoms around that time. Symptoms vary by individual; some women will have symptoms the day before their period begins, while other may not have them until the next day or the end of their cycle.

“If we can identify when in the cycle the migraine reliably happens, we have some nice techniques that we can teach our patients so that they can hopefully avoid the migraine from even happening,” says Dr. Engel.

Some women can take their migraine medicine the day before their period starts, for example, to prevent headache from developing. There appears to be a link between women who get their headaches on the last day of their period and low iron due to the blood loss; taking an iron supplement may ward off the headache.

Using birth control pills also can lead to hormone headache. Some women have worsening migraines when they begin taking oral contraceptives, but that doesn’t necessarily mean they need to stop.

“Often they just need a few weeks or a couple of months for their brain to adjust to this change, and then they often do just fine,” says Dr. Engel. “And some women also might feel that they need to stay on the pill, because when they’ve stopped it in the past, their migraines have flared up. Again, just be a little patient to give the brain a chance to catch up. Often the migraines diminish.”

Pregnancy brings on major hormone shifts and, not surprisingly, pregnant women frequently develop headaches in the first trimester as their bodies adjust. Often, these headaches improve during the second and third trimesters when the hormones have stabilized a bit.

Later in life, as menstrual cycles wind down, so do some hormones. Especially during perimenopause, hormone levels can change daily, not just around menstruation. As a result, some perimenopausal women may have a headache almost daily.

“A lot of women come see me in their mid to late forties with worsening of their migraines. There are really beneficial hormonal treatments that many women can take to help them in perimenopause,” says Dr. Engel.

“About 20 years ago, a study came out which scared a lot of doctors and patients away from hormones,” she adds. “But now what we know is that topical hormone replacement, through the skin as a cream or patch, for most women is actually very safe and very effective.”

If you believe your headaches are related to perimenopause or menopause, Dr. Engel recommends talking with your gynecologist about hormone replacement therapy.

“It’s important to work closely with your gynecologist, your primary care doctor and your neurologist or headache specialist to make sure that you’re not suffering and that your symptoms are well-controlled.”

At any age, lifestyle changes, such as going to sleep and waking at the same time every day, exercising at the same time every day and not skipping meals, can help manage migraine. Over-the-counter pain relievers and prescription medications also can help with relieving headache pain or even preventing migraine.

“Most women get hormonal headaches, so this is not an unusual condition, and you shouldn't be suffering,” says Dr. Engel. “Reach out to your primary care doctor or seek care from a specialist. We can help get it under excellent control so that it's not disabling and it’s not disruptive.”