Common Stressors
Estrogen and the menstrual cycle
Why migraine is three times more common in women, and how estrogen changes affect attacks.
5 min read · 8 research sources · Based on the Mastering Migraine courses by Dr. Adam Harcourt
Before puberty, boys and girls get migraine at similar rates. After puberty, women are affected about three times as often as men 1,2. Sex hormones, especially estrogen, are a big reason why.
Estrogen and the migraine brain
Estrogen affects pain pathways, CGRP, serotonin and how excitable nerve cells are 1,3. It is not high or low estrogen alone that matters most, but change. A sudden drop in estrogen, like the one just before a period, is a well-known trigger 3.
Menstrual migraine
- Pure menstrual migraine: attacks only around the period (from two days before to three days after it starts).
- Menstrually related migraine: attacks around the period plus at other times 4.
Menstrual attacks are often longer, more severe and harder to treat than other attacks 5.
Differences between men and women
Men and women with migraine differ in brain structure and function, in how attacks behave, and in how they respond to treatment 6.
The stress-hormone connection
The stress system (HPA axis) and the reproductive hormone system (HPG axis) talk to each other constantly. Chronic stress can disrupt reproductive hormones, and hormonal shifts can change how the body handles stress 7.
What can help
- Tracking attacks alongside your cycle in a headache diary
- Hormone testing when appropriate, to see the full picture rather than a single snapshot. See Hormones: testing and balance.
- Vitamin E around the period has been studied for menstrual migraine 8
- Timed treatment plans developed with your prescribing physician
This article is educational and does not replace a personal evaluation. Talk with your clinician before making changes to medications, supplements or diet.
Research cited on this page
- Borsook D, Erpelding N, Lebel A, et al. Sex and the migraine brain. Neurobiol Dis. 2014;68:200-14. PubMed 24662368 · DOI
- Burch R, Rizzoli P, Loder E. The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache. 2018;58(4):496-505. PubMed 29527677 · DOI
- Chai NC, Peterlin BL, Calhoun AH. Migraine and estrogen. Curr Opin Neurol. 2014;27(3):315-24. PubMed 24792340 · DOI
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. Source · DOI
- Petrovski BÉ, Vetvik KG, Lundqvist C, et al. Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. J Headache Pain. 2018;19(1):27. PubMed 29611008 · DOI
- Delaruelle Z, Ivanova TA, Khan S, et al. Male and female sex hormones in primary headaches. J Headache Pain. 2018;19(1):117. PubMed 30497379 · DOI
- Li W, Diao X, Chen C, et al. Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients. J Clin Neurosci. 2018;50:165-171. PubMed 29366620 · DOI
- Shaik MM, Gan SH. Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine. Biomed Res Int. 2015;2015:469529. PubMed 25815319 · DOI
Mastering Migraine is an educational resource and is not a substitute for individualized medical care. Always talk with your own doctor before changing medications, starting supplements, or beginning a new treatment.
