Estrogen and Migraines
While the causes of migraines are not understood completely, we do think that the female hormone estrogen may affect the way our bodies perceive pain. Estrogen levels can affect levels of chemicals such as serotonin that help regulate the dilation of blood vessels around the brain. These same chemicals also make the nerves surrounding the brain more sensitive to pain. The central nervous system is affected by these normal fluctuations in hormones. Other sources of estrogen may include oral contraceptives and hormone replacement therapy (HRT) used during menopause.Menstrually Related Migraine (MRM)
Estrogen-withdrawal migraine or Menstrually Related Migraine (MRM) is now being recognized as a separate subcategory of migraines. As estrogen levels fall right before menstruation, some women experience an increase in migraines, especially those who have migraines without aura. Migraine headaches seem to change in character at different stages in a woman’s life as well, varying during puberty, pregnancy, lactation, and menopause. Research is being done to determine whether estrogen supplementation is a valuable tool in treating MRM.Migraines and Vascular Disease
A 2008 study published in Neurology discusses a gene that may, in some women, relate migraine headaches with heart attack and stroke. Roughly 11% of people carry to copies of the gene alteration, or are "recessive" carriers of the gene alteration (alson known as "polymorphism). Women that have this gene alteration and also have migraines with aura are up to 3 times more likely to have a cardiovascular incident. It is too early to recommend genetic testing for all migraine sufferers, but some researchers are recommending that women with migraines (especially those with aura) should consider discontinuing estrogen-containing medications. Of course, anyone considering a medication switch should discuss this with her doctor.Sources:
MacGregor EA. “Menstrual Migraine.” Curr Opin Neurol. 2008 Jun;21(3):309-15.
Martin VT; Behbehani M. “Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis.” Headache. 2006 Jan;46(1):3-23.
Pringsheim T, Davenport WJ, Dodick D. “Acute treatment and prevention of menstrually related migraine headache: evidence-based review.” Neurology. 2008 Apr 22;70(17):1555-63.
Winner P; Ricalde O; Le Force B; Saper J; Margul B. “A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine.” Arch Neurol. 1996 Feb;53(2):180-4.
