Headaches and hormones: What's the connection?

Being female has some real health advantages, but not when it comes to headaches — particularly migraines. Fortunately, there's help.
In a given year, 18 out of 100 women age 12 and older experience at least one migraine headache, a misfortune that strikes only 6 pecent to 7 percent of men. What's behind the difference? The answer, in a word, is hormones, but the explanation is far from complete.

The role of hormones
Many factors contribute to headaches for both men and women, including family history and age. Women, however, often notice a relationship between headaches and hormonal changes.

Headaches often begin around the time of a girl's first period and accompany menstruation regularly throughout the reproductive years. Birth control pills and hormone therapy also can trigger headaches. During pregnancy, headaches often become less bothersome.

The simple explanation? The hormones estrogen and progesterone — which play key roles in regulating the menstrual cycle and pregnancy — may affect headache-related chemicals in the brain as well. Higher estrogen levels may improve headaches, while lower estrogen levels can make headaches worse.

What's a woman to do?
Fluctuating hormone levels may influence headache patterns. But you're not totally at the mercy of your hormones. Your doctor can help you treat — or prevent — headaches.

During menstruation
The drop in estrogen just before your period may contribute to headaches and increase your sensitivity to pain. Headache is a common symptom of premenstrual syndrome, and up to 60 percent of women with migraines report headaches before or during menstruation.

Over-the-counter pain relievers can relieve many menstrual headaches. Lifestyle matters, too. Eat healthy foods. Exercise regularly. Keep stress under control. Practice relaxation techniques. Get plenty of sleep.

If you have menstrual migraines, nonsteroidal anti-inflammatory drugs — such as naproxen (Aleve, others) and ibuprofen (Advil, Motrin, others) — are often the first line of treatment. Sometimes it's enough to take one of these medications when you feel a migraine beginning. In other cases, a stronger prescription medication is needed. If you have three or more debilitating headaches a month, your doctor may recommend preventive treatment with these or other medications.

If your menstrual cycle is regular, it's often most effective to take preventive headache medication starting a few days before your period and continuing through the first few days of your period. If you have migraines throughout your menstrual cycle or your periods are irregular, it may be better to take preventive medication every day.

If you use birth control pills
Some women experience headaches for the first time after starting birth control pills or other hormonal methods of birth control. For others, hormonal birth control changes existing headache patterns — sometimes for the better, sometimes for the worse.

If your method of birth control seems to trigger headaches or make them worse, consult your doctor. Sometimes it helps to use a monthly pill pack with fewer inactive (placebo) days or to eliminate the placebo days completely from most cycles. In other cases, you may choose a progestin-only birth control pill or another type of contraception.

During pregnancy
Estrogen levels rise rapidly in early pregnancy and remain high throughout pregnancy. Migraines often improve or even disappear during pregnancy. Sometimes tension headaches improve as well. After delivery, an abrupt decrease in estrogen levels may trigger headaches.

If you have headaches during pregnancy, ask your doctor about treatment options. Many headache medications may have harmful or unknown effects on a developing baby, especially if you take them regularly at the time of conception.

If your headaches get better during pregnancy, you may enjoy the same improvement while you're breast-feeding. Lactation stabilizes estrogen levels and increases the levels of other hormones that help reduce sensitivity to pain. Although you'll need to be cautious about headache medications while you're breast-feeding, you'll have more options than you did during pregnancy.

During menopause
Menopause is another prime time for changing headache patterns. For most women, migraines improve once their menstrual periods cease — but tension headaches often get worse. Hormone therapy can affect headaches, too. Menopausal hormone therapy worsens headaches in some women and improves headaches in others, in just about equal proportions.

If your headaches persist after menopause, you can continue to use the same medication and lifestyle measures as always. If you choose to use estrogen to manage the signs and symptoms of menopause, your doctor may recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen, which is least likely to aggravate headaches.

Every woman is unique
Some women are more sensitive to the effects of hormones. If headaches are disrupting your daily activities, work or personal life, ask your doctor for help. Treatment is available.