Do your migraines come like clockwork? Do they occur either just before or after your period?
During women’s reproductive years, migraine is three times more common than in men of a similar age.
Migraine is a predominantly female disorder.
Women, compared with men, have a 1-year migraine prevalence nearly 3-times higher and a lifetime incidence more than 2-times higher. Prior to puberty migraines are reported to affect both sexes equally.
Migraine in women usually start after menarche and then occur more frequently in the days just before or during menstruation, and often reduce or even disappear during pregnancy and menopause.
This hormonal relationship with migraine also extends to include the oral contraceptive pill (OCP) and hormone replacement therapy (HRT). The affect may be positive or negative, depending on several factors, but nethertheless this further confirms the relationship between migraine and female hormones in some female sufferers.
So, why do female hormones have this effect for some?
To understand the effect of hormones you need to understand the cause. Migraines are known to be a neurological problem and widely believed to be a sensory processing problem. Whilst there is growing evidence that this may be caused by specific changes in the brain, particularly the mid brain, it is known that a significant contributor for many people is dysfunction in the trigeminovascular pathway.
This pathway takes sensory information from the face, eyes, ears, teeth and jaw and uses it to assess potential risks to your life. Because of this importance the pathway is hard wired into your flight or flight responses, the stress areas of the brain.
In addition, the same nerve also takes input from blood vessels and the coverings around the brain.
When this system gets wound up, inflammation occurs at the nerve endings releasing various chemicals, such as CGRP, which sensitize the system. The result for many is the natural beating of arteries in the brain is felt leading to a throbbing headache feeling.
How do hormones effect this?
There are specific female hormone receptor sites on the trigeminovascular system. It is proposed that when someone already has an irritated mid brain and trigeminovascular system with associated inflammation, female hormonal changes are enough to cause further irritation triggering a migraine.
Which hormone affects you is very hard to establish. Estrogen can stimulate these receptors and we tend to see this with women who get migraines just prior to the period. If the change is due to progesterone changes or a significant drop in estrogen, we tend to see migraine occur after the period has started.
The timing of menstrual migraines can tell us a lot about which hormone is causing your problems and what needs to be done about it.
Diagnosing imbalances is critical to working out the best strategy to correcting migraines. A combined approach of reducing structural irritation on the midbrain and trigeminovascular system, balancing hormonal function and specific biochemical support seems to provide great relief for many people we see.
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