Hormonal migraines & period headaches: How to cope

PMS. Three little letters, a mountain of annoyances, inconveniences, and, for some of us, serious debilitation during that time leading up to your period. PMS = premenstrual syndrome, although nowadays the term is often used to describe a broader portion of the menstrual cycle—from the days leading up to when your period starts all the way to the day or two after your flow comes to an end.  

PMS is more than the rollercoaster of emotional ups and downs that pop culture would have us believe. It’s actually a clinically defined syndrome.

The American College of Obstetricians and Gynecologists (ACOGACOG stands for the American College of Obstetricians and Gynecologists (a professional membership organization for obstetrician–gynecologists).) defines PMS as having at least one affective symptom and one somatic symptom during the five days before the start of your period, but only when these symptoms are consistent across at least two consecutive menstrual cycles.¹ That’s a mouthful right there, so let’s break it down.

Affective symptoms include things that affect how you perceive and react to the world, like your mood, anxiety levels, or social withdrawal from activities you’d usually enjoy. Somatic symptoms are those felt by your body and can include the usual things like muscle aches (especially in your pelvic or lower stomach region), tender breasts, swelling and mild weight gain, along with things like an upset stomach and menstrual headaches. 

Hold up. That last symptom isn’t one of the usual suspects listed off when we talk about PMS—butit is a very real phenomenon, and one that isn’t talked about nearly as often as it should be.

Menstrual headaches are one of the symptoms of PMS, and they sit within the broader category of hormonal migraines. Migraines (hormonal or not) are actually one of the most common neurologic disorders worldwide, and they affect women 3:1 compared to men.²

So, if you’ve always gotten brutal headaches during your period (or around) and you’re wondering why, you’re in the right place: We’ve covered everything you need to know about hormonal migraines below, including the biological cause, accompanying signs and symptoms, and a few unconventional ways to kick headaches to the curb. 

Breaking down the connection between headaches and hormones

Overall, the mechanism for how headaches happen is multifactorial (meaning, there are a bunch of different processes at play). In general, it involves the dilation or widening of blood vessels in the brain, as well as the release of neurotransmitters and the trigeminal nerve that together produce the sensation of pain. 

Interestingly, biological males and females have similar rates of headaches until puberty—at which point, the number of individuals AFABAFAB stands for “assigned female at birth.” who experience headaches shoots way up. What could be driving this change? Some theories suggest that hormones are at play.

Estrogen, or the lack thereof, is thought to be the main culprit. The reason for this isn’t well understood yet, but it may have to do with how estrogen affects gene expression, causing changes in local inflammation and prostaglandin release. 

What causes hormonal migraines?

You might still be wondering, “but, why do I get migraines on my period?” If that sounds like you, here’s what the research tells us about the link between sex hormones and menstrual headaches: Several studies have shown that period migraines are often triggered by the drop in estrogen that precedes the luteal phase—the phase after ovulation, leading up to your period.³

It’s not that simple, though. At physiologic, or non-medical, “natural” levels, estrogen can prevent the pathways leading to migraines…but at medical dose levels, they can actually stimulate those pathways that produce painful headaches. Basically, estrogen is dose-dependent, meaning that the amount of estrogen released can vastly change how your body responds (and whether or not it produces a headache or migraine).  

In case this explanation wasn’t already complicated enough: Estrogen isn’t the only hormone at play when it comes to menstrual migraines. Serotonin is also involved.  

Serotonin is a neurotransmitter that’s involved in a plethora of processes in your body, affecting characteristics ranging from mood to memory. Migraines are also associated with a low-serotonin state. Something else that’s interesting? There’s a school of research that thinks that ovarian steroid hormones are potentially involved in serotonin synthesis, i.e. how serotonin is “manufactured” in the body, taking this conversation to a whole new Inception-like level.⁴

Long story short, we don’t yet know exactly what causes hormonal migraines in people with uteruses, but scientists and researchers are fairly certain it has to do with fluctuations in estrogen levels as well as the amount of serotonin present in your system.  

What’s the difference between a hormonal headache and a hormonal migraine?

Ah, the age-old question: What really is the difference between a headache and a migraine?

Migraines are basically headaches, “premium edition.” They don’t just include the typical throbbing ache in your skull, but also involve symptoms like nausea, vomiting, sensitivity to light or sound, or aura (visual or auditory disturbances).³

Migraines are episodic. There are pre-defined triggers that lead up to an uncomfortable pre-migraine phase, then the migraine attack itself, then the post-migraine recovery. People sometimes also experience migraine with auras. This could range from “seeing stars” or flashing lights, noticing blind spots in your vision, or experiencing sensory numbness or tingling.

In terms of location, migraines tend to be localized to one side of the head, whereas a standard headache may feel as if it’s spread all the way throughout your forehead and scalp and is equally distributed on both sides of your head.  

Migraines by definition also happen more than once, and there is at least one identifiable trigger. In other words, they’re recurring and can be attributed to a certain trigger event or occurrence (like reaching a certain phase of your menstrual cycle).  

You can get both hormonal headaches and hormonal migraines: Both are caused by a fluctuation or change in hormonal levels, but the latter just involves those additional symptoms mentioned above.

Hormonal migraines vs. headaches: Signs & symptoms

Most of us have had the garden-variety headache at one point in our life, which is a dull ache that comes on seemingly without any reason. Or, you might get headaches frequently but you know exactly why—whether it’s sleep deprivation, staring at your computer screen for a few hours too long, being hungover, or not drinking enough water. So, here’s your daily reminder to go refill that glass and drink up!

But for headaches that are recurrent, it can be really difficult to differentiate between a hormonal migraine (or headache) and a standard headache.  

The signs and symptoms of both hormonal headaches and non-hormonal headaches will be fairly similar, with the common thread of pain that can be felt in the forehead, temples, or other parts of the head. This pain is usually dull and throbbing in nature, but it can also feel like a sharper, stabbing sensation. 

The best way to tell if you’re having a hormonal headache or migraine is by paying attention to the timing: Are you in the luteal phase of your cycle? Are you approaching peri-menopause? Did you recently give birth? What about changes in medication, like stopping or starting hormonal contraceptive pills?

 Hormonal headaches are diagnosed based on their presumed hormonal etiology. This could mean:

• Stage of your menstrual cycle, e.g. many people with hormonal headaches will feel them come on soon after the drop in estrogen levels that takes place during the luteal phase
• Relationship to external factors, such as medications or medical conditions (some known ones are nitrates, sometimes prescribed for heart conditions, and oral contraceptives, a.k.a. hormonal birth control pills)
• Stage of life in relation to menopause (i.e.: hormone replacement therapy sometimes used during peri-menopause, menopause)

Where are hormonal headaches located?

One other way that headaches can be differentiated from each other is based on location. However: Keep in mind that this isn’t always a perfect fit, and that not everyone experiences hormonal migraines or headaches the same way.⁵

Tension headaches: In general, tension headaches are on the forehead and top of the head, both sides, and are described as a mild to moderate pressure headache. These are the most common types of headaches.

Sinus headaches: Sinus headaches are often a sign of sinusitis, or inflammation of the sinuses related to an ongoing infection. These ones are related to the sinuses, which are little collections of air that sit behind the eyes, nose, and mouth. When you’re sick, they can fill up with fluid, pus, or other secretions, leading to pressure headaches in that area. Sinus headaches will often come with other signs of infection, like a runny nose, sneezing or coughing, and eye irritation. 

Cluster headaches: In contrast to the other types of headaches, cluster headaches are usually severe, one-sided headaches that must come with at least one of the following additional symptoms:

• Eye irritation, including teary eyes, swelling in the eyelids, or pupil changes
• Nasal congestion
• General restlessness, agitation, malaise

Hormonal headaches: Hormonal headaches can have any distribution, but the most common is that tension-type distribution, so both sides on the top or front of the head. Hormonal headaches are more about the cause of the headache (a change in hormones) than they are about the location.

Hormonal migraines: Unlike hormonal headaches, hormonal migraines (and migraines of any type) are often localized to one side of the head, and the pain consistently recurs in that area. Some people may feel the pain start at their temple and extend down the entire side of their face.⁶

How to cure hormonal migraines

The question of the hour: “I’m having hormonal headaches literally right before I start my period, or during my period. WTF do I do about it??”

Here are a couple tips for how to make your period headaches go away:⁷

NSAIDS say what? NSAIDs, or non-steroid anti-inflammatory drugs, are actually one of the most effective medications for headaches. NSAIDS = OTC meds like Advil, Motrin, and Aleve. Generic names = ibuprofen and naproxen.

Studies have shown that these work super well for reducing headache symptoms even at low to moderate doses. For specific recommended dosages, read the back of the label or reach out to your healthcare provider. 

Note: Tylenol (acetaminophen) is NOT an NSAID! It doesn’t work the same way as Advil or Aleve and generally isn’t as effective when treating headaches or migraines. However, it may provide mild relief for some, especially if you are unable to tolerate ibuprofen or naproxen or have a history of stomach ulcers. 

Hydration is key. Dehydration is one of the most common triggers for headaches—and if you’re already prone to hormonal headaches, being dehydrated will only make them worse. To ward this off, make sure you’re drinking your requisite amount of water (around 3 liters per day for most women, according to the Mayo Clinic).⁸

Pro tip? Toss a lemon in there to make it feel fancy and get you to drink more. Lemons also have anti-inflammatory properties, which can make you feel better from the inside out.

Thx Starbux! Fun fact for all those caffeine lovers out there: Evidence shows that, in low doses, caffeine can actually help with the symptoms of headache! This works via that vasoconstriction mechanism we talked about earlier.  

Headaches happen due to global vasodilation, or widening of blood vessels in the brain and the secretion of substances that induce pain. Caffeine opposes this by vasoconstricting those blood vessels. So go forth with your cup o’ Joe or other caffeine source of choice (like green tea, black tea, oolong, or dark chocolate). Just make sure to have a cup of H2O for every cup of caffeine, since caffeine is known to be dehydrating.  

Exercise, but proceed with caution. The jury’s still out on exercise and its effects on headaches. Much of it seems to be person-specific. For some folks, that daily 5-miler run can stave off the symptoms of PMS including headaches; for others, all that pounding just makes your head pound even more.

For this one, try to stick to low-impact types of exercises to reduce headache symptoms. Examples could include yoga, swimming, a short walk, or some gentle stretching.  

Inhale some soothing scents. Creating an environment that’s easy on the senses is key to preventing headaches—and helping you get through them once they’ve arrived. Try lowering the lights, reducing any major sound exposure, and investing in a diffuser for at-home aromatherapy. 

Essential oils have been used for generations, and while there isn’t as much research on them as there maybe should be, anecdotal evidence has shown lavender, peppermint, rosemary, and eucalyptus to work especially well for headaches. However, keep in mind that everyone reacts differently to certain scents: Start slow, especially if your headaches or migraines have sensory components. Test different scents to see what works best for you and stick with 1-2 drops at first.

Ice it out. Many chronic migraine sufferers turn to an ice pack or a cold washcloth when the throbbing pain gets especially intense. While it might not be an immediate cure, using cold therapy can make it easier to get through a headache. Try laying down with a damp washcloth over your forehead and an ice pack on top for 15-20 minutes at a time.

Grab those shades. If you tend to get headaches at random, be prepared by keeping a pair of your favorite sunglasses on your person at all times (along with water and a bottle of your NSAID of choice). Headache pain tends to feel worse when your eyes are exposed to bright light, so keeping them protected behind your shades is the best way to cope when you’re out and about.  

When to see a doctor

While most headaches are run of the mill and nothing major to worry about, there are a couple of warning signs you should be familiar with.⁹ If you experience any of the below, get yourself to the emergency room.  

• Headache that comes on quickly, sharply, and/or doesn’t relent for hours on end
• Headache with fever
• Headache with stiff neck
• Severe sensory changes like temporary blindness, deafness, or difficulty speaking
• Passing out or loss of consciousness
• Feeling “out of it,” dizzy, or experiencing memory loss or unusual changes in mental faculties
• “First or worst” headache of your life

These are just a couple of guidelines, but if you ever feel truly terrible during a headache episode then reach out to a healthcare provider ASAP.

Hormonal headaches & migraines: Key takeaways

Headaches are one of the most common conditions worldwide, and people AFABAFAB stands for “assigned female at birth.” are affected more than those AMABAMAB stands for “assigned male at birth.”. There are several buckets of headaches, including tension headaches, sinus headaches, cluster headaches, hormonal headaches, and migraines—which are headaches that come with specific sets of additional symptoms. 

For immediate headache relief, over-the-counter NSAIDS (like Advil or Aleve) are the best way to go. You can also try remedies like (moderate amounts of) caffeine, aromatherapy, and low-flow exercise. However: If you ever get a headache along with any of the warning signs listed above, or experience a headache that just won’t go away after multiple days, contact your healthcare provider ASAP. 

Hormonal migraines and headaches are yet another symptom that people with uteruses often struggle with at certain points in their cycle. Hopefully, this guide has given you a few tools to help you cope. Just know that, next time a migraine strikes, you’re not alone! We’re right there with you, cold washcloth on forehead and all. 

This article is for informational purposes only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.

^{© 2021 The Flex Company. All Rights Reserved.}