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Migraines and women: Is it hormones?

A woman in pain massages her forehead.

Keeping a headache diary and working closely with your doctor may help you find relief.

Migraine is three times more common in women than in men, according to the National Institute of Neurological Disorders and Stroke.

Why is that? The exact cause of migraine is not fully understood. But headache experts say the painful attacks can often be traced to a list of common triggers. One of the items on that list is hormone changes during the menstrual cycle.

If you're a woman living with migraine, that might not be a surprise to you. But if you've noticed a pattern to your headaches, that's actually a good thing. Sharing this information with your doctor can help you find the right solution for you.

Treatment generally includes both lifestyle changes and medications to lessen the number and the severity of the headaches that you get. Sometimes special devices can help too.

Hormones and other triggers

Girls and boys get migraine headaches at about the same rate before puberty, according to the American Migraine Foundation. But once puberty arrives, migraine frequency in girls begins increasing.

That's one reason that female hormones are believed to be a trigger.

Even women who get cycle-related headaches may have other migraine triggers too, including:

  • Getting too little or too much sleep.
  • Skipping meals.
  • Stress or anxiety.
  • Weather changes.

Attacks also are sometimes linked to certain foods or beverages—like aged cheeses, alcohol (red wine in particular) and nitrate-containing foods (like hot dogs and lunch meats).

Make an appointment with your doctor

It's always a good idea to see your doctor about frequent or serious headaches, whether you think they're migraines or not.

Headaches can be caused by some other medical condition—for example, a sinus infection.

You can help your doctor by providing as much information as possible in the form of a headache diary. Before you see your doctor, keep a record of your headaches. Some things to include:

  • Where the pain was situated.
  • When it occurred (time of day, point in menstrual cycle).
  • What you did, ate or drank in the 24 hours before the headache started.
  • How long it lasted.
  • What helped or worsened the pain.

Migraine can run in families. So let your doctor know if anyone in your family has migraines. And bring a list of any medications you take, both prescription and over-the-counter (OTC).

Treating migraines

All of the above will help your doctor develop a treatment plan, which is likely to include one or more of the following:

Relief medicine. OTC drugs like ibuprofen and acetaminophen may work on mild pain. But they usually fall short for more serious headaches. In those cases, triptans, such as Imitrex or Zomig, or ergot derivatives (ergotamine tartrate and dihydoergotamine) are the first line of treatment.

Preventive medicine. Drugs originally developed for other health conditions, like epilepsy or high blood pressure, can reduce the frequency of migraines. Botulinum toxin injections, which are often used to treat muscle spasms, can help prevent migraines too. A newer option for migraine is erenumab (Aimovig). Monthly injections of the drug help reduce the number of migraine attacks a person may have by blocking a molecule involved in them.

Lifestyle changes. Your headache diary can help identify triggers, which you can then try to avoid. This might include limiting certain foods, adopting new sleep habits or learning relaxation techniques.

Medical devices. In recent years, several neuromodulation devices have received U.S. Food and Drug Administration approval to treat or prevent migraines. Such devices may be an alternative for people living with migraines, according to the American Migraine Foundation. The devices use electrical currents or magnets on nerve pathways to change brain activity. Some of the devices are portable, and others require surgical placement. One of these devices may be a good option if you have a lot of trouble with side effects from your migraine medicine.

Work closely with your doctor

If your treatment plan doesn't seem to be working, talk with your doctor. You may need a different type or dosage of medication. Or your doctor might refer you to a counselor or other specialist for help.

Reviewed 3/3/2023

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