Hormonal Update Volume 3 Number 6

Migraines... Hormones Giving You a Headache?

Headaches are one of the most common complaints doctors hear in their offices. There are tension headaches that arise from stress, sinus headaches that are due to swollen or inflamed nasal passages, and muscle-contraction headaches that stem from spasms at the back of the neck. For most people, the Rx is fairly simple - take a little aspirin, ibuprofen, or antihistamine and relax. On the other hand, anyone who has ever experienced a migraine knows it is the headache of all headaches and relief doesn't come that easily. Often described as a searing, blinding or knife-like pain in the head, with extreme sensitivity to light and sound, the pain of a migraine can be so severe it frightens sufferers into thinking they have a brain tumor, or an aneurysm.

Over twenty-seven million people in the United States - that's one person in every four households - suffer from migraines. Women during their reproductive years, ages fifteen to fifty, have five times as many migraine headaches as men. In fact, it has been estimated that seventy percent of all migraine sufferers are women. The frequency with which women have these nasty headaches has led science to believe that hormones may be a factor. New scientific studies have shown that hormonal fluctuations and imbalances can indeed cause a migraine. In this Hormonal Update we take a look at the different ways that hormones can impact these serious, often incapacitating, headaches.

Recognizing a Migraine

Just like other headaches, migraines can be felt in the front, back, one side or the entire head. However, that is where the similarity ends. Unlike other headaches, the pain of a migraine can be so extreme that it is completely debilitating. Migraines are also distinctly different from other headaches in that they develop in stages. Generally, by the time a migraine really takes hold, it has been coming on for hours, maybe even days.

The initial phase, which is marked by changes in energy, mood, sensory perception, even cognitive ability is called the prodrome phase. Muscle aches and pain, food cravings and irritability can also be signs that a migraine is coming.

Next comes the "aura" phase that brings with it changes in vision, such as silvery streaking, or flashing lights. During the aura phase, hearing can also be affected, often by a sense of echoing in the ears. And, there can be numbness or tingling in the fingers. In the past it was believed these symptoms were caused by the contraction of blood vessels in the head. New research tells us they are caused by an electrical phenomenon in the brain.

Migraines actually begin with an excitation of brain tissue that takes the form of an electrical current-like wave that travels across a specific area of the brain, followed by a completely still phase. Then, the blood vessels dilate and constrict, which brings on the third, or actual headache phase of the migraine. It often starts with mild pain, similar to a tension headache. But, this is short-lived; the pain soon grows into excruciating, vascular throbbing frequently accompanied by nausea and vomiting. The only option for many migraine sufferers once the headache is in full force is to lie down in a completely darkened and quiet room, and remain completely still until it passes.

Determining the Cause

These ferocious headaches can be caused by foods - known offenders are caffeine, alcohol, red wine, chocolate, peanuts and aspartame. There are also common food allergens that are culprits - wheat, sugar, corn and dairy foods. Hypoglycemia, temperature changes, low serum levels of magnesium, and stress can all generate a migraine. Fluctuating or rapidly declining hormones can also trigger a migraine.

Statistics show that for two thirds of the women who suffer from migraines there is a hormone connection, with menstrual migraines being the most common form of migraine. Occurring within two days before the onset of menses and four days after, menstrual migraines seem to be caused by changes in estrogen and progesterone levels. Low levels of these hormones, variations in the ratio between them, or a sudden drop in circulating estrogen can all precipitate a migraine. Women who are prone to menstrual migraines experience an escalation in frequency as they approach menopause, when hormone fluctuations can intensify.

Interestingly, new research suggests that high levels of estrogen and progesterone can deplete the body of the mineral magnesium. Magnesium affects serotonin receptors in the brain and has been found to help regulate neuronal excitability, as well as other migraine related chemicals such as nitric oxide. Magnesium is known to help with PMS symptoms as well as migraine headaches. This may mean that during the late luteal phase of a woman's cycle, when estrogen and progesterone are reaching a peak, it may be advisable to supplement with extra magnesium.

Determining the cause of a migraine is of prime importance in deciding how to treat it. If the headache is food related then abstinence from the offending foods could help minimize their risk. If it is caused by stress, then stress relievers like yoga, meditation, and aerobic exercise may help. Aerobic exercise stimulates the release of endorphins, the body's natural pain relievers. However, if a migraine is hormonal in origin then food restrictions or stress relief techniques may not be of much help.

Saliva hormone level testing is particularly helpful for women with hormonal migraines. It allows health care providers to track how a woman's hormone levels are changing throughout the month. A baseline saliva hormone level test can determine what a woman's hormone levels are at a specific time. A series of tests taken throughout the month can reveal hormonal fluctuations, peaks and valleys, or dramatic changes that occur suddenly. Saliva hormone level testing can also expose consistently low levels such as those that occur at menopause. For women with hormonally triggered migraines saliva hormone level testing can give fast, accurate answers that lead to an effective treatment plan.

Managing Migraines

Nearly half of all migraine sufferers treat themselves with over the counter medications. Twenty three percent take prescription medications. However, while these remedies can bring relief, many of them also come with uncomfortable side effects. Beta blockers can cause low blood pressure, decreased libido and depression. Other medications such as periactin (cyproheptadine) or amitriptyline affect neurotransmitters and can cause sedation, dry mouth, and increased appetite and weight. The ergot alkaloids can cause nausea.

Birth control pills can be prescribed for migraine treatment and prevention in an attempt to stabilize or regulate hormone levels for perimenopausal women. However, it’s important to remember that birth control pills are a form of hormone replacement and alter a woman's hormone levels. If the dosage is correct it, can help minimize migraine risk. But if too high, it can increase headache frequency, and intensity.

For both menstrual and menopausal migraines hormone replacement therapy (HRT) is a viable option. However, there are a number of factors relevant to the success of an HRT protocol for migraines. Because too much estrogen can as easily cause a migraine as too little, determining and monitoring the dosage is very important.

A hormone's delivery system also plays a very important role in the success or failure of hormonal treatment for migraines, as does the level of patient compliance. If a woman forgets to take her hormones, or decides to stop for a while, it can alter her hormone levels and potentially increase her migraine risk.

Hormones can be taken orally or transdermally. Oral hormones are subject to something called first pass elimination by the liver. This means they can be broken down, metabolized and eliminated, or bound with carrier proteins and deactivated, when they pass through the liver. It's a process that can greatly reduce the amount of hormone available for absorption. For example, a typical estrogen dosage is one or two milligrams. When you take estrogen in tablet or capsule form the amount that actually gets into your system and used by your tissues is only ten percent of that. In addition, after ingestion, the peak estradiol level usually occurs within four to eight hours and then declines within twelve to sixteen hours to baseline level. For a migraine sufferer whose headaches are caused by a sharp drop in estrogen and who needs stable estrogen levels throughout the day, oral dosages need to be taken every twelve hours.

On the other hand a transdermal application of estrogen, such as the patch, delivers a continual dosage throughout the day. Studies have shown that this continual release of hormones into the system tends to stabilize hormone levels more effectively than pills. Once the patch dosage has been determined, monitoring hormone levels can insure the dosage remains constant, neither too high nor too low.

New Areas of Investigation