Beyond Migraine Podcast — Episode 2: Migraine and the Influence of Hormones

This article is part of a sponsored series linked to each Beyond Migraine podcast episode brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland. Please tune in to hear more on these topics and encourage people you are treating for migraine to listen in.

Migraine can be influenced heavily by hormones. At various stages of life, hormones can become more active – for example, at the onset of puberty, establishing a menstrual cycle, pregnancy or menopause. Approximately 60% of women with migraine note an increased number of attacks coinciding with their menstrual period.

In episode two of Beyond Migraine, Dr Mary Kearney, a GP with a special interest in migraine who co-authored The Irish College of General Practitioners’ Migraine Quick Reference Guide and Anna Daly, Virgin Media TV presenter and businesswoman, discuss the influence of hormones on migraine.

Many women experience their first migraine during their teenage years, mostly around the onset of menstruation. Oestrogen and progesterone levels decrease during menstruation or at menopause, which, in turn, can trigger a migraine attack.

In the Migraine and Hormones episode of Beyond Migraine, Dr Kearney said, “With pure menstrual migraine, people do not get headaches at any other time in the month, the attacks occur exclusively around the time of menstruation and at no other time, Typically, pure menstrual migraine occurs two days before a period and continues for three days into the period.” It is thought that about 10% of women who suffer from migraine suffer from pure menstrual migraine.

Dr Kearney continued, “Pure menstrual migraine can also be easily confused with menstrually-related migraine. Menstrually-related migraine is when women may notice an increased number of attacks around the time of their period, but they will usually suffer from migraines at other times of the month as well.”

Hormonal migraine can be treated like most other migraines. “A diary is essential in trying to establish a pattern and to try and understand if migraines are hormonally linked. Keeping a diary enables the person to look at all their trigger factors. Factors to consider are hydration levels, eating patterns, sleep patterns and stress levels. If these factors negatively coincide with the menstrual cycle, a migraine can be triggered, so it is important that all triggers are assessed rather than just looking at hormone levels.”

For Anna Daly, it took her a long time to realise the connection between her headaches and her hormones, but over time she could link them to the first and the last day of her menstrual cycle. During the podcast, Anna talked about her pregnancy, and migraine in particular – another key time when hormone levels change significantly, which can positively or negatively impact on migraine. Anna commented, “The one thing that affected me was not Morning Sickness or any of the obvious things that you can be affected by during pregnancy, it was headaches. So, again, it reinforced the hormonal connection for me with my migraines.”

“I remember looking forward to a Spa break with friends. I was heavily pregnant, but I was excited about going. I was in the hotel for an hour and suddenly I felt the headache come over me. I spent the rest of the day in the bedroom while everyone was enjoying themselves.” For Anna, the frustration of a migraine occurring and having to disappoint people is one of the worst things about experiencing migraine “There’s a sense of not wanting to let people down. You feel really disappointed in yourself. You almost try and hide it a bit. When people say, do you still have that headache, you’re almost embarrassed by saying, yes, I do.”

Dr Kearney outlined in the episode that for most women, migraine improved in pregnancy because the oestrogen level rises, but there are a minority that suffer really badly during pregnancy, particularly during the first pregnancy. Dr Kearney advises women to be prepared, and to understand that they may need to take some time out. Build your support network of family or friends who can be available to support if this is required.

For women whose migraine is closely linked with their menstrual cycle, the onset of menopause can result in real improvement. Dr Kearney said: “It is possible that a person’s migraine attacks might lessen – but it’s also possible that they might increase. Such is the unpredictability of hormones. It’s during the perimenopause stage that you need to really try to understand the triggers and address the risk factors because when hormones are fluctuating it’s difficult to control them.”

Dr Kearney continued: “For some people migraines can improve, for others, in their early forties, it’s possible to get a migraine for the first time. If the cause is the menopause, it is most likely occurring in the perimenopause stage when oestrogen levels are fluctuating. But, once the menopause comes and the hormones level out, the chances are migraines will reduce in regularity.”

You can listen to the Beyond Migraine episode featuring Dr Mary Kearney and Anna Daly here.

The series can be streamed via the Migraine Association of Ireland website as well as wherever you listen to your podcasts.

For more information on migraine, you can visit Neurologybytes. This is an online news and education platform dedicated to neurology, where healthcare professionals working in neurology can discover bite sized content on the latest developments, with a particular focus on migraine and MS. Read more about migraine on www.neurologybytes.ie.

The Beyond Migraine podcast is supported by funding from Teva Pharmaceuticals Ireland. Speakers have received an honorarium for their contribution to the podcast.