Hormonal Headache

Headaches, particularly migraines are common in perimenopause, some women only begin to experience them in the phase leading to menopause.  Many women (up to 40 %) report that they typically occur in the last half of their menstrual cycle, or occur during menses.  It is often thought that perimenopausal and menopausal headaches are related to decreasing estrogen levels, but this is not typically the case and it is more related to the imbalance of estrogen and progesterone.  Further, perimenopausal headaches can be stubborn in that conventional treatments for headaches (NSAIDS, beta-blockers, and tricyclic antidepressants), do not seem to work.  The best way to determine if you are suffering from perimenopausal headaches is to keep a headache diary to determine triggers and to track your menstrual cycles.  If it is determined that you are suffering from hormonal headaches, blood tests can determine if it is because you have an imbalance between estrogen and progesterone.

Progesterone therapy may effectively prevent and treat “hormonal” headaches because it calms neurons in the brain by acting on GABA receptors similar to the effects of valium but without the addictive side effects.  Progesterone therapy can be used in conjunction with conventional treatment (NSAIDs, beta-blockers, triptans, and tricyclic antidepressants), or used alone.  If patients do not want to take oral progesterone therapy (Prometrium), bioidentical progesterone cream can be an effective preventative and treatment option for migraine headaches.

If you would like more information, or would like to trial bioidentical progesterone therapy for migraine headaches, please reach out to me.

Michelle Koch MN:NP