Migraines. Tension headaches. Vascular headaches. TMJ pain. All forms of headaches, except cluster headaches, are three to five times more common in women, with this gender difference beginning at puberty and disappearing after menopause.
Could there be a clue in those statistics? Are there hormone changes in women that contribute to their greater frequency of headaches, particularly migraines?
If you have ever suffered from a migraine, then you know how desperate a woman can be to find relief for the throbbing, head-splitting pain coupled with nausea that makes you ill just to think about moving around, frightening visual changes that can make you think you’re having a stroke, and generally feeling that you want to hide in the darkest room you can find.
Missed Headache Causes
Headaches in general can have many different causes – from relatively simple things like foods, drinks, “rebound” from headache medicines, and barometric pressure changes, to potentially life-threatening causes like meningitis, strokes, and aneurisms. Most of the time, doctors are good at sorting out serious from not-so serious causes and steering you in the right direction for treatment.
But in addition to these causes, my patients tell me that during their menstrual years, they often have headaches that consistently happen like clockwork just before or when their periods start, and also frequently with ovulation.
Unfortunately doctors too often don’t “connect the dots” and identify the culprit in these menstrual headaches as a falling estradiol with menses, or after birth of a child, or after hysterectomy, or during the wildly erratic cycles before menopause, or from the low estradiol and testosterone levels after menopause. This overlooked hormone trigger is missed in better than 95percent of women with migraines, even though it can be helped in some fairly simple ways,
Yes, It Could Be Your Hormones
Most of my headache patients who observe a clear pattern of headaches with their periods have asked doctors “Could it be something with my hormones?”
But they are told, “Hormone changes don’t cause headaches, and we can’t check hormones anyway.” Then they get a prescription for Effexor, Toprol, Elavil, Imitrex, or Stadol” or some other headache medicine.
Since migraine is commonly a woman’s disorder that included many unusual symptoms, it was all too frequently discounted by doctors who labeled it hysterical or psychological. They thought women were “stressed” from all their homemaking and childcare demands.
We now know migraine is a biological disorder with genetic roots. Pioneering studies of Dr. B.W. Somerville, published in the early 1970s, showed conclusively migraine headaches in women were triggered by a drop in estradiol (that’s the primary type of estrogen made by the ovary).
Estradiol level (along with progesterone, beta-endorphin, and serotonin levels) decreases dramatically the last few days of your menstrual cycle to its lowest point on the first two days of bleeding, then remains low for the first four to five days of the new cycle, and again falls sharply around ovulation.
But missing this hormone connection causes both unnecessary suffering and increased cost of treatment from all the other medicines used and the ER visits for control of severe headache pain. The good news is that there are some hormonal treatment options that work extremely well for many women. I describe a number of these, along with patient stories, in detail in my book Screaming To Be Heard: Hormone Connections Women Suspect and Doctors Ignore.
There are several other common hormone causes for headaches in women: hypo and hyperthyroidism, excess prescription thyroid (especially excess T3, as in Armour thyroid or Naturthroid), excess progesterone (common with the 100mg and 200 mg compounded progesterone creams), excess DHEA often recommended for “adrenal fatigue” without checking women’s estradiol and other hormones, or excess testosterone (I often see this with Estratest, and with women given the excess 1 percent and 2 percent compounded testosterone creams or gels).
Treating Hormone Headaches
When I see a new patient with headache problems that may be related to hormone imbalances, I check blood levels of the various hormones and metabolic factors that can cause the problem.
If there is a documented low estradiol level, I offer my patients a chance to try an FDA-approved bioidentical estradiol patch or gel or lotion for those days of the cycle when estradiol is low or falling. That approach treats the underlying cause, and in a short time, we have a clear indication of what’s working and what’s not so we can make adjustments as needed.
Here are five action steps I recommend if you have been having headaches that aren’t responding well to the usual treatments you have tried:
1. Eliminate the “lifestyle”-related headache triggers: alcohol, cigarette smoking, lack of sleep, toxic stress, lack of aerobic exercise, overuse of supplements and over-the-counter stimulants, decongestants, or pain medicines.
2. Watch for “rebound” headaches as pain medicines, antidepressants, and/or mood stabilizers wear off between doses.
3. Read the free booklet on my website outlining the medical tests I think are important to identify hormone and metabolic headache triggers and ask your doctor to do blood tests to check your hormones.
4. Practice autogenic conditioning, relaxation/deep breathing, or visualization exercises as a natural way of breaking the headache-pain vicious cycle.
5. Ask your doctor about trying some of the hormone strategies I have described in detail in my books.
You don’t need to suffer side effects of multiple medications or suffer unrelenting headaches. There is a common-sense approach to evaluating and treating hormone headache triggers.
For more information about Dr. Vliet, visit her website.
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