Migraines and Hormones: Why Women Are More Affected

Women make up about Three times more likely to suffer from migraines than men after puberty [1]. The main culprit: hormonal fluctuations, particularly the drop in estrogen levels at the end of the menstrual cycle. Understanding the connection between Migraines and Female Hormones enables women to anticipate health crises, adjust treatments, and make informed decisions about contraception, pregnancy, and menopause. This article provides a comprehensive overview of the topic, from the first period through postmenopause.

On this page

• Why do hormones affect migraines?
• What is a menstrual migraine?
• Migraines and Birth Control: What You Need to Know
• Migraines During Pregnancy
• Perimenopause and Menopause
• Crisis Interventions
• Preventive Strategies
• Lifestyle Habits That Help
• When to consult?
• Myths and Misconceptions
• Frequently asked questions
• Sources

Why do hormones affect migraines?

L’estrogen plays a central role in modulating brain pain and in the sensitivity of blood vessels in the head. When its levels drop rapidly—such as just before menstruation, after childbirth, or during perimenopause—the brain becomes temporarily more susceptible to triggering a migraine attack [2].

The periods of greatest risk

• The 2 days before and the first 3 days menstrual periods (drop in estrogen levels)
• Ovulation in some women
• The week off while taking combined birth control
• The Postpartum Period (sudden drop in hormone levels after childbirth)
• Perimenopause (irregular cycles, significant fluctuations)

Some Key Figures to Keep in Mind

• Environment 18 % for women suffer from migraines, compared to 6 % for men [1]
• 60 % in women with migraines report a connection with their menstrual cycle [3]
• Visit menstrual migraines are, on average, longer and more intense than the others
• Most women who suffer from migraines experience their attacks improve by 2^e and 3^e quarters pregnancy
• After the menopause, many women notice a marked decrease in their attacks

What is a menstrual migraine?

Visit menstrual migraine is a migraine without aura that occurs during a specific window of the cycle: 2 days before your period (D-2) à 3 days after they began (Day 3). The ICHD-3 international classification [4] distinguishes between two forms.

Pure Menstrual Migraine

• Occurs exclusively during the window from D-2 to D+3
• At least 2 out of 3 cycles
• No crises outside of this period
• The rarest form (about 10 % of women with migraines)

Menstrual Migraine

• Crises in the perimenstrual window: Day 2 before to Day 3 after at least 2 out of 3 cycles
• But as well as crises at other times during the cycle
• Most common form

Typical Characteristics

• Frequent seizures more severe and longer-lasting than the others
• Less responsive to conventional pain relievers
• Preceded by a premenstrual syndrome noted (fatigue, irritability, swelling)
• A rarer aura only in off-cycle migraines
• Often severe nausea and vomiting

Migraines and Birth Control: What You Need to Know

The choice of the Contraception for Women Who Suffer from Migraines must take into account the type of migraine (with or without aura), the frequency of attacks, and vascular risk factors (smoking, high blood pressure, family history).

Migraine without aura

• Visit combination pill (estrogen-progestin) may exacerbate or improve Migraines, According to Women
• A continuous-cycle birth control pill (without a hormonal break) often reduces withdrawal-related episodes
• Visit transdermal patch or the’vaginal ring can also be considered
• A personalized discussion is required to assess the risk-benefit ratio

Migraine with aura

• Visit The combined oral contraceptive pill is generally contraindicated according to scholarly societies [5]
• At issue: a increased risk of ischemic stroke, increased 2- to 4-fold in women with migraine with aura who are taking combined oral contraceptives
• The risk is amplified smoking, being over 35 years old, and high blood pressure

Alternatives to discuss

• Progestin-only contraceptives (birth control pill, injection, implant, hormonal IUD)
• Copper IUD (hormone-free)
• Barrier Methods (condom, diaphragm)
• Sterilization if the family project is complete

Every woman who suffers from migraines should report their seizures to their doctor when choosing or renewing a birth control method, especially if you have an aura or have recently experienced a worsening of symptoms.

Migraines During Pregnancy

Pregnancy significantly alters the migraine profile, often for the better but not always.

Typical Development

• Visit the majority of women with migraines (60–70 %) see their seizures improve at 2^e and 3^e quarters [6]
• Some women experience their first migraines as of 1^er quarter
• Visit postpartum is a high-risk period (sudden drop in hormone levels)
• L’breastfeeding has a partial protective effect in some

Therapeutic Precautions

• Several migraine medications are contraindicated During Pregnancy — An Essential Discussion with Your Doctor
• Acetaminophen Approved at the usual dose
• NSAIDs Avoid on the 3rd^e quarter (and conservative use prior to that)
• Triptans : Use is evaluated on a case-by-case basis based on the benefits and risks
• Non-pharmacological approaches priorities (rest, hydration, ice, a quiet environment)

Warning Signs During Pregnancy

• New Migraine or a change in pattern
• Severe, sudden headache («a bolt from the blue»)
• Headaches with high blood pressure, blurred vision, and abdominal pain — possible preeclampsia
• Extended Aura or unusual neurological symptoms

Any unusual headache during pregnancy warrants a rapid medical evaluation.

Perimenopause and Menopause

Visit perimenopause (the years leading up to the permanent cessation of menstruation, generally between the ages of 45 and 55) is marked by significant and unpredictable hormonal fluctuations. This is often a time when migraines temporarily worsen.

During perimenopause

• Possible worsening seizures with irregular cycles
• New episodes in some women who had previously been symptom-free
• Importance of keep a journal crises and cycles
• Vascular evaluation and discussion of hormone therapy options

After Menopause

• Reduction in seizures among the majority women
• Hormonal stabilization after 12 months without a period
• Some women find that their migraines persist, especially if they weren't strictly hormone-related

Menopausal Hormone Therapy

• L’hormone therapy may improve or exacerbate Migraines, as Experienced by Women
• Visit transdermal route (patch, gel) generally provides more consistent drug release than the oral route
• Visit low to moderate doses are preferred
• In the presence of’will have, requires an in-depth discussion due to the vascular risk

Key Takeaways

• Visit Women are three times more likely to be affected by migraines than men after puberty
• Visit drop in estrogen levels At the end of the cycle is the main hormonal trigger
• Visit migraine with aura generally contraindicates the combined oral contraceptive pill
• Visit Pregnancy improves migraines in the majority of women aged 2^e and 3^e quarters
• Visit perimenopause may worsen seizures, the postmenopause often improves them
• Several preventive strategies and acute conditions exist—medical follow-up allows for individualized care

Crisis Interventions

Visit Acute treatment of a hormonal migraine is based on the same principles as migraine in general, with a few specific characteristics.

Main Options

• Triptans (sumatriptan, rizatriptan, zolmitriptan) — when taken early in an attack, they are very effective
• NSAIDs in sufficient doses (ibuprofen, naproxen) — can be combined with triptans
• Acetaminophen alone or in combination — moderate effectiveness
• Antiemetics (metoclopramide, domperidone) — for severe nausea
• Gepants (ubrogépant, rimégépant) — an alternative to triptans, especially if there are contraindications

Practical Tips

• Start treatment early during the crisis — more effective
• Limit the frequency No more than 2–3 days a week to avoid overuse headaches
• Hold a Crisis Log to identify patterns and triggers
• Avoid opioids and butalbital as a regular treatment

Preventive Strategies

When seizures are frequent or debilitating, several preventive strategies may be recommended, particularly for hormonal migraines.

Perimenstrual mini-prophylaxis

• NSAIDs (naproxen) or long-acting triptan (frovatriptan, naratriptan) for 5 to 7 days around the time of menstruation
• Particularly useful in cases of pure menstrual migraine or related to menstruation
• Helps avoid daily preventive treatments

Conventional Preventive Treatments

• Beta-blockers (propranolol, metoprolol)
• Antiepileptic drugs (topiramate, valproate—the latter is contraindicated during pregnancy)
• Antidepressants (amitriptyline, venlafaxine)
• Calcium channel blockers (verapamil, flunarizine)

Modern Targeted Therapies

• Anti-CGRP (erenumab, fremanezumab, galcanezumab) — monthly or quarterly injection, for refractory forms
• Gepants for prophylaxis (atogepant, rimegepant)
• Botulinum toxin for chronic migraine (≥ 15 days/month)

Supplements and Non-Pharmacological Approaches

• Magnesium (300–600 mg/day) — may reduce menstrual cramps
• Riboflavin (vitamin B2) (400 mg/day)
• Coenzyme Q10 in some female patients
• Acupuncture, biofeedback, meditation
• Regular physical activity, regular sleep, hydration

Are your migraines related to your menstrual cycle or a hormonal change? Omicron Clinic evaluates hormonal migraines at our locations in Quebec: contraception adjustments, acute and preventive treatment plans, prenatal care, and hormone therapy for menopause. Make an appointment or view in teleconsultation for a personalized assessment.

Lifestyle Habits That Help

• Regular Sleep (consistent schedules, sufficient duration)
• Regular meals — Avoid skipping meals
• Hydration throughout the day
• Limit caffeine and alcohol, especially during the premenstrual period
• Identify personal triggers (food, scents, light, stress) through a journal
• Regular physical activity (without overdoing it during sensitive periods)
• Stress management techniques (meditation, yoga, breathing)
• Prescription glasses on-screen and good ergonomics at work

When to consult?

Warning Signs — Seek Medical Attention Immediately

• Sudden headache and intense («like a thunderclap»)
• Headache with fever, stiff neck, and confusion
• Extended Aura (> 1 hour) or unusual (motor, sensory)
• First Migraine after age 50
• New pattern Headaches during pregnancy
• Neurological symptoms lingering after the crisis

Regular checkups are recommended

• Cycle-Related Crises that result in more than 1 to 2 days of disability per month
• Migraine with aura on the combined oral contraceptive (contraceptive review)
• Another migraine during pregnancy or after childbirth
• Failure or Intolerance in addition to standard treatments
• Frequent Seizures requiring acute medication more than 2–3 days a week
• Worsening of symptoms during perimenopause or the onset of new seizures at this age

Myths and Misconceptions

«Hormonal migraines go away during menopause.»

Nuanced. Many women notice a marked improvement after menopause, but this is not always the case. Migraines that are not strictly hormone-related may persist. Perimenopause itself is often a period of temporary worsening.

«All women who suffer from migraines should avoid the birth control pill»

False. Only migraines with aura are a relative or absolute contraindication to the combined oral contraceptive pill. Women with migraines without aura can often use combined contraception—particularly the continuous-use regimen—after evaluation of other vascular risk factors.

«Chocolate and red wine cause all the problems»

Overrated. Certain foods can trigger attacks in people who are predisposed to them, but the role of «trigger foods» is often less significant than irregular sleep, stress, dehydration, or hormonal fluctuations. Keeping a personal journal can help identify the factors that are truly relevant.

«Triptans are dangerous in the long term»

Mostly fake. Triptans used as recommended (no more than 10 days per month) are safe for long-term use in most women without vascular risk factors. A consultation with a doctor will clarify any individual contraindications.

«If migraines improve during pregnancy, they won't come back.»

False. The improvement during pregnancy is largely due to the stabilization of estrogen levels. The postpartum period (marked by a sudden drop in hormone levels) is often a time of rebound. Most women return to their usual pattern a few months after giving birth.

Frequently asked questions

How can I tell if my migraines are caused by hormones?

The best tool is a seizure diary kept over 3 to 6 months, noting the date of the seizures, their intensity, their duration, and the date of your period. If seizures occur primarily during the window from 2 days before to 3 days after your period in at least 2 out of 3 cycles, a hormonal link is likely. This log also helps your doctor recommend an appropriate treatment strategy.

Does breastfeeding protect against migraines?

To some extent, in some women. Breastfeeding keeps estrogen levels relatively stable and low, which can prolong the improvement seen during pregnancy. When breastfeeding stops and menstrual cycles resume, migraines often return to their usual pattern.

Is hormone therapy for menopause dangerous for women who suffer from migraines?

Not always. In the absence of an aura or a history of major vascular events, and when using a transdermal route with a moderate dose, hormone therapy may be considered. For women with migraine with aura, the decision is more complex and requires an individualized assessment of the benefit-risk ratio.

Does magnesium really work?

Several studies suggest that magnesium (300 to 600 mg per day) may reduce the frequency of migraines—particularly menstrual migraines—in some women. The effect is modest but real, with few side effects (mainly gastrointestinal). A 2- to 3-month trial allows for an assessment of the individual’s response.

Are anti-CGRP medications covered in Quebec?

Anti-CGRP medications (erenumab, fremanezumab, galcanezumab) are covered by the RAMQ and several private insurance plans under certain conditions, generally after failure or intolerance to at least two conventional preventive treatments. The request requires a medical form and prior authorization.

Is a new migraine during pregnancy a cause for concern?

Any new migraine—especially if it is severe or accompanied by persistent visual disturbances, abdominal pain, high blood pressure, or swelling—should be evaluated promptly to rule out preeclampsia or another medical cause. Follow-up with your primary care physician or obstetrician is essential.

Sources

1. Migraine Canada. Epidemiology of Migraine in Canada.
2. Canadian Headache Society. Migraine and Female Hormones: Reviews and Guidelines.
3. Society of Obstetricians and Gynecologists of Canada (SOGC). Migraines, Birth Control, and Pregnancy.
4. International Headache Society. International Classification of Headache Disorders (ICHD-3).
5. Quebec College of Physicians (CMQ). Migraine and Contraception: A Clinical Approach.
6. INESSS — National Institute for Excellence in Health and Social Services. Clinical Tools for Migraine.
7. Quebec Health Insurance Board (RAMQ). Coverage for Migraine Treatments.

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