According to a Lancet review, migraines tend to occur during the premenstrual phase due to prostaglandins, histamine, and the steep decline in estrogen (aka “estrogen withdrawal”) leading up to the period.
Body-identical progesterone can shelter the brain from that estrogen withdrawal and reduce the frequency and intensity of menstrual migraines.
The link with high, fluctuating estrogen
Menstrual migraines are more common with high, fluctuating estrogen and relatively low progesterone, such as during perimenopause. That’s why menstrual migraines are more common between the ages of 40 and 55.
High, fluctuating estrogen promotes migraines by 1) stimulating immune cells to produce more prostaglandins and histamine and 2) leading to steep estrogen withdrawal, which disrupts the neurotransmitters serotonin and glutamate.
đź’ˇTip: Migraines have been linked with “plumes” of the excitatory neurotransmitter glutamate moving in waves through the brain.
By reducing glutamate and calming the brain, progesterone may help prevent menstrual migraines.
Research has also linked high levels of the hormone prolactin to migraines. Read about lowering prolactin.
Natural treatment of menstrual migraines
- Magnesium shelters the brain from glutamate and can reduce the frequency and severity of migraines. It also stabilizes serotonin receptors, reduces inflammation, and prevents the release of substance P, a pain-promoting neurotransmitter. Magnesium combines well with taurine, a calming amino acid that can also work for migraines.
- Bioidentical or body-identical progesterone works best when taken during the two weeks leading up to the period and is available as Prometrium or Utrogestan capsules. See the migraine section in my perimenopause book, Hormone Repair Manual. (Note: There’s no progesterone in any hormonal birth control because contraceptive drugs are progestins, not progesterone.)
- Riboflavin or vitamin B2 may also help to prevent migraines and works by normalizing the production of serotonin and improving the function of the MTHFR enzyme, which has been linked to migraines.
- Melatonin reduces inflammation and can work as well as amitriptyline for migraine prevention.
- A gluten-free diet was found in one study to eliminate migraines in 89 per cent of participants. A possible mechanism is that gluten sensitivity can cause high glutamate by triggering an autoimmune reaction against the enzyme (glutamate decarboxylase) that converts glutamate to GABA.
- Finally, iron supplements can be helpful, but only for post-menstrual migraines or end-menstrual migraines, which are caused by brief iron-deficiency anemia resulting from menstrual blood loss.
Hormonal birth control can worsen migraines
All types of hormonal birth control can worsen migraines, and for women who are prone to migraines, estrogen pills carry a significantly higher stroke risk.
💡 Tip: If you develop a severe throbbing headache with the hormonal IUD, check with your doctor because it could be a rare condition called intracranial hypertension.
