Menstrual Migraines: The Estrogen Link

For some women, migraines are closely linked to their menstrual cycle, with migraines occurring during or just before menstruation with symptoms ranging from severe head pain to nausea, sensitivity to light and sound, and disrupted daily activities. This phenomenon is known as menstrual migraines. While the exact cause is not fully understood, research suggests that the interplay between hormonal fluctuations, particularly low estrogen levels, and increased levels of calcitonin gene-related peptide (CGRP), a neurotransmitter involved in pain signaling, may contribute to the onset of migraines during menstruation.

Estrogen’s Role in Migraine: Estrogen, a hormone that fluctuates throughout the menstrual cycle, has a complex relationship with migraines. It is believed that declining levels of estrogen, specifically during the premenstrual and menstrual phases, can trigger migraines. Estrogen withdrawal is thought to affect the regulation of serotonin, a neurotransmitter involved in pain modulation, as well as the dilation and constriction of blood vessels in the brain, which are implicated in migraine pathophysiology.

CGRP and Migraine: Calcitonin gene-related peptide (CGRP) is a neuropeptide that plays a significant role in migraine development. Elevated levels of CGRP are found in individuals experiencing migraines, and research suggests that CGRP may contribute to the dilation of blood vessels and the transmission of pain signals associated with migraines. During menstruation, the combination of low estrogen levels and increased CGRP levels may create an environment more prone to migraine initiation.

Impact of Low Estrogen and Elevated CGRP: The decrease in estrogen levels observed during menstruation is thought to lead to increased excitability of the trigeminal system, which is involved in migraine pain pathways. Low estrogen levels may also trigger neuroinflammation and disrupt the balance of other neurotransmitters implicated in migraine, such as dopamine and gamma-aminobutyric acid (GABA). Additionally, elevated CGRP levels can further sensitize the trigeminal system, contributing to the development of migraines during this time.

Understanding the connection between migraines and menstruation can help you develop effective strategies for managing your menstrual migraines. While anti-inflammatory drugs, CGRP inhibitors or hormonal therapies may be prescribed to stabilize estrogen levels, you may also find relief with adopting a holistic approach.  This can involve various lifestyle modifications and  include dietary changes, using herbal remedies, maintaining a regular sleep schedule, practicing stress reduction techniques such as mindfulness meditation and deep breathing exercises, and engaging in regular physical activity to promote overall well-being and reduce migraine frequency.

Sources:

  • MacGregor, E. A. (2020). Menstrual migraine: Therapeutic approaches. Journal of Headache and Pain, 21(1), 1-9.
  • Pavlovic, J. M., et al. (2017). Neurobiology of menstrual migraine. Headache, 57(3), 407-415.
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