More than 50 per cent of migraines or headaches experienced by women occur around menstruation and ovulation. One possible explanation is that the drop in oestrogen known to occur at these times in the menstrual cycle leads to lower levels of serotonin. Regulating oestrogen levels seems to be able to reduce the incidence of migraines by influencing one of the subtypes of serotonin receptors responsible for preventing serotonin-induced blood-vessel spasm and inhibiting the pro-inflammatory changes that cause the pain of migraines.
However, oestrogen fluctuations are only one of a number of triggers for migraines. Most women who have menstrual migraines also experience migraines at other times during the cycle, indicating that their migraines are caused by factors other than changes in hormone levels. The common triggers are blood sugar fluctuations; muscular tension and structural problems in the neck and upper torso; food allergies; sinusitis; motion from travelling in car, bus or boat; various weather patterns; and changes in sleep cycles.
In other words, many women who experience menstrual migraines have menstrual magnification of a pre-existing migrainous problem that is exacerbated by the changing levels of oestrogens. It is therefore appropriate to suggest some intervention that will assist with changes in hormones, while primarily focusing on identification and rectification of the underlying triggers. Treatments can therefore be complex, and in addition to hormone modulation might involve appropriate dietary changes (hypoglycaemic diet, exclusion of identified food triggers), chiropractic or osteopathic treatment for neck and back problems, appropriate remedies for chronic sinusitis and introduction of stress-management techniques.
Headaches and Migraines: The medical approach
The most common medical treatment for menstrual migraines is either oestrogen patches to regulate oestrogen levels, or the Pill; however, some women develop migraines while taking the sugar pills (with no hormones) triggered by the drop in oestrogen levels. Peri-menopausal women are usually given oestrogen patches because the levels of oestrogen remain more stable than when oestrogen is taken orally. Some women will continue to experience migraines if the dose is too low while others might experience symptoms if the dose is too high, particularly if there are additional surges of endogenous oestrogen. The progestogens necessary for women who have a uterus can exacerbate migraine, but this can be reduced with low-dose continuous patches where possible.
Headaches and Migraines: A natural therapist’s approach
To control menstrual migraines, a herbalist might suggest Vitex agnus-castus in combination with Cimicifuga racemosa throughout the cycle. Tanacetum parthenium is also useful as a prostaglandins inhibitor that can reduce incidence and severity of migraine headaches. Lavandula officinalis and Verbena officinalis are useful as relaxing nervines, while Corydalis ambigua is an effective anodyne. Magnesium supplementation may help because of the tendency for levels to be low amongst migraine sufferers premenstrually.
A trial examining the effectiveness of soy isoflavones in combination with Angelica sinensis and Cimicifuga racemosa decreased migraine incidence by more than half, pointing to a possible hormone modulating effect of isoflavones and the two herbs. Women who have migraines also frequently have lower levels of the anti-inflammatory prostacyclin PGI 2. Fish oils may improve the ratio of this protective prostaglandin and help to reduce the incidence of migraine (and period pain).