Do you get migraine headaches in perimenopause or menopause?

Hormonal headaches, menopause headaches or menstrual migraines, these are common in women in their fertile years, and through the years that we deal with perimenopause and beyond. These types of headaches can also increase while going through the menopause transition.

According to the Cleveland Clinic, 60% of women experience hormonal headaches. This review confirms that there is a possible increase of headaches in perimenopause, with a decrease as women leave this stage.

If you are heading towards post-menopause, you may be getting some headache relief! Menopause headaches are less frequent for some women than in perimenopause. 

If you suffered through menstrual migraines while younger, you may be in for some more of them while you go through the perimenopause to post-menopause transition.

When the post-menopause period settles in, the incidences of migraine may drop down to 14%.

Women who suffer with migraines or menopause headaches may:

• Have a history of daily tobacco use.

• Have a history of daily alcohol use.

• Have a history or oral contraceptive use or hormone therapy.

• May have started menopause younger.

• Have had surgical menopause.

This blog post is going to share 11 root causes of menopause migraines and some natural headache remedies to ease your suffering.

Regular Headache and Menopause Headache: what’s the difference?

Many women get menstrual migraines (MM), hormonal headaches and tension headaches right through perimenopause. How do you know if you are experiencing a headache or a migraine?

Here are some differences:

Common Headaches:

Penn Medicine notes that some common types of headaches in all ages include tension headaches and sinus headaches. They also talk about cluster headaches, which, for me, was also an occurrence with migraines through my adult life. 

Here’s a quick breakdown:

Tension headache: feelings of pressure, mild to moderate discomfort, may extend to shoulder muscles. I have had tension headaches from clenching and grinding my teeth.

Sinus headaches: oh man! I think we’ve all had this one! When we have a cold or sinusitis the congestion in your sinuses can cause all kinds of pain, including behind the eye or even tooth pain!

Cluster headaches: these can happen daily and routinely, at the same time. One cause of this might be the release of histamine which can trigger a headache. 

Migraine headaches

Migraine headaches are classified as a disorder with subtypes: migraine without aura, and migraine with aura. Both men and women experience migraines, with women having a 43% lifetime cumulative migraine experience over men at 18%.

The Menstrual Migraines (MM) may be more painful and harder to get rid of than Non Menstrual Migraines (NMM). They can also last longer, and many of us have had those horrible period headaches that go on for days!

Some days the perimenopause headache was worse than the period itself!

This may all relate to the hormonal swings that women experience with the estrogen swing of perimenopause, which has also been called the “estrogen withdrawal hypothesis”. With the drop of estrogen that comes with perimenopause, migraines in menopause rear their ugly head.

What Causes These Menopause Headaches?

There are various potential triggers to headaches, whether they are due to hormones or tension. Please visit your licensed care physician if you struggle with headaches or any other health condition.

Here are 11 root causes of menopause headache:

1. Blood vessel instability.
One cause, according toThe Encyclopedia of Natural Medicine, is blood vessel instability. What does this even mean? There may be a restriction in blood flow before the migraine, and then the blood flow increases and the migraine ensues. This blood vessel action occurs on the outer parts of the brain.This may be inherited or genetic.

2. Stress.
Whatever the stressor, something in your environment, or an event or stressful thinking, this can be a trigger to a migraine headache. We are more susceptible to stress at different times in our lives, and cortisol may play a role in headaches. When you are stressed, you are in one of these responses: fight, flight, freeze or fawn mode - this impacts blood sugar, and muscle tension which can play a role in headaches.

3. Food triggers. 
Many foods can trigger a headache, including the beloved coffee that perks us up, and the wine that we think relaxes ups. Both can trigger headaches, including migraines. They can also mess with your sleep, which in perimenopause, is already becoming more disrupted, leading to headaches. Common foods that can trigger migraines include:

• Artificial sweeteners

• Red wine

• Chocolate

• Cheese

• Milk

• Nitrates in processed meats

• Even citrus in susceptible people
  

4. Dehydration.
Maybe your dehydration is from the coffee and wine 😂? Seriously, lack of hydration can trigger a migraine. As we age, we also have more difficulty in holding on to hydration in our bodies. Our thirst cues are also changing! Our busy lives can also have us forgetting to hydrate, leading to, and often prolonging, those headaches.

5. Clenching your teeth.
If you suffer from teeth grinding, otherwise known as bruxism, you may be waking up with headaches. Did you know that even clenching can create muscle strain and headaches? You may not even be aware of clenching through the day. This clenching or grinding may be related to sleep apnea, acid reflux, alcohol or other recreational drugs, and even some medications.

There are health conditions that may cause this oral behaviour. Ask your dentist or dental hygienist about any possible grinding or clenching signs if you struggle with morning headaches.

6. Skipping meals.
Have you ever had a hunger headache? Skipping meals can bring on a migraine in some people due to the drop in blood sugar. When you are not getting enough calories and your blood sugar starts dropping, you may even get muscle tension.

7. Posture.
Have you ever left your computer or desk with neck strain? You may also end up with a headache. We can lapse into poor posture if we are not careful! Looking down at your laptop, your phone and even neglecting the muscle chain along the spine can lead to head forward posture and headaches. People who have sensitivities and allergies may have developed head forward posture due to the need to open their airway.  

8. Degenerative Disc Disease.
Ah, the fun of aging. We lose water in our discs in our spine and the structure can change. Add in mechanical stress like that head forward posture and we can end up with DDD or degenerative disc disease. Bending forward as a dental hygienist is what caused mine!

9. Hormones
We’ve already touched on this, the fluctuating and decreasing levels of estrogen and progesterone. When there is an excess of estrogen over progesterone, headaches can arise. High cortisol may also lead to headaches. There is also a link between thyroid hormone and headaches too! 

10. Low serotonin. 
There could be a link between low serotonin and migraine in menopause as well! Serotonin is a neurotransmitter that helps your nerve cells talk to each other. It can also narrow, or constrict blood vessels.

11. Weather.
Some of us have a headache come on when the weather changes. This may be due to brain chemicals, like serotonin, changing. Or the barometric pressure shift creates pressure in the sinuses with headache as a result.

Wherever that menopause migraine comes from, when you have it, you want to get RID of it. Here’s a few things to help you with your headaches in perimenopause or menopause.

Start Tracking Your Headaches.

Many foods can trigger a migraine, including the very things we crave while experiencing PMS. Track what you eat, along with your headaches in a journal. it may seem tedious, but logging your headaches and foods for as least a month may help you see if there is a food-headache connection.

The theory behind food and headache is that certain foods (listed above) contain more histamine and other chemicals that make the blood vessels relax and dilate. This relaxation of the blood vessels can bring on a migraine.

Diamine oxidase is an enzyme that works in our gut to break down histamine. When we ingest food histamine, this enzyme works to break that histamine down. If we are low, or deficient in diamine oxidase or DAO, the histamine doesn’t break down.

Keeping food diaries can be difficult if you are trying to stop dieting or if you have an eating disorder. Apps that track food may also count calories, so if this triggers excess worry about your body, go for pen and paper and journal foods + headaches.

A note about alcohol:

Alcohol is dehydrating, depletes nutrients, and the ethanol in alcohol can trigger a headache. Alcohol is a diuretic, like coffee, and this is where the dehydration headache comes into play. Drinking also relaxes the blood vessels of the body, and this increases blood flow, and possible headache.

A note about coffee and caffeine withdrawal:

Coffee withdrawal causes headache, and if you have ever quit coffee, you KNOW what I mean. This may be due to changes in blood flow and brain rhythm without the caffeine. If you feel like caffeine is an issue for you, start to decrease slowly. You can cut your regular coffee with decaf, green tea or a chicory/dandelion type beverage.

A note about cheese:

Cheese, specifically aged cheese, has more tyramine in it. If you’re looking for a food specific list of triggers you can click here. It’s a document from the University of Wisconsin, School of Public Health.

Track Your Menstrual Cycle

If you are not doing this already, track your cycle. This will help you see if your headaches are hormonal in nature.

Support your Hormones. 

If your headache comes just before your period when levels of estrogen and progesterone are changing, you may need some hormonal support. What does that look like? It can be things like:

• Liver support

• Stress reduction and resilience building

• Supplements to help balance your hormones

• Having your thyroid checked

Diet Changes

While elimination diets might be helpful if you have a histamine issue, or are suspecting there are certain foods that trigger a headache, they are not always a long term solution if they are calorie restrictive and narrow.

Restricting food groups changes the microbiome in the digestive system and may leave you nutrient deficient in your later years.

Make sure you are getting enough fiber and a wider variety of plants in your diet. If you have constipation, work towards alleviating this, as your digestive system is a main elimination pathway for toxins.

The digestive tract is an area where your broken down hormones go to be eliminated. Making sure that you are pooping at least daily is important, to keep the toxins the body makes from recirculating and staying in your system.

Plus: the gut has a microbial community called the estrobolome, and this helps metabolize estrogens!

Magnesium

This is a commonly deficient mineral in many women. Magnesium citrate is used to help with bowel movements, and relaxation of muscles. This relaxation can help with period cramps and tension headaches. Magnesium glycinate also calms our nervous system. It may block certain substances that can cause migraines.

Stop Skipping Meals.

If your menopause headaches are coming from meal skipping, it may be time to look at your eating patterns. Many women in the perimenopause to menopause transition worry about their weight.

We can be tempted to restrict our diets in midlife, when fat can accumulate around the middle. This desire to take off pounds can deplete your body of nutrients, including magnesium.

It may also work against another important health factor in menopause, and that is balanced blood sugar.

With the popularity of intermittent fasting as a way to weight loss, headaches can occur. Tune in and pay attention to your meal timing and eating patterns. If you are fasting pay attention to:

Dehydration. While the practice of fasting may encourage calorie free liquid, many women DO NOT take in adequate liquid and dehydration can trigger headaches.

We need water for our body processes, and we get that from sources like fruits and vegetables, which also give us micronutrients and fibre to keep that elimination pathway of digestion moving.

Blood sugar dysregulation. Our brains do use glucose for energy. The brain is the first organ to be affected if we have our glucose levels drop. Headache can be one symptom of having a drop in blood glucose, and this can happen easily if you are counting calories, skipping meals, and ignoring your hunger.

We can get so hungry that we have an overriding drive to just eat, and we go for quick acting carbohydrates to fuel our bodies and our brains. This is your biology working. This is where a mindful approach to eating may be helpful.

Skipping meals can impact energy, muscle mass, and bone health. This may also cause headaches. Why? We need adequate energy and nutrients for our nervous system to function. We need B vitamins for our nervous system, and B2 (Riboflavin), is helpful for migraine headaches. If you’re taking or thinking of taking supplemental B2 speak to a professional to make sure your B’s are balanced out. 

Support serotonin.

Serotonin has an impact on our emotions, but did you know that it impacts our whole body? 

Low serotonin is implicated in our digestive system, our cardiovascular system, our nervous system (headaches), with cravings, sleep disturbances, and painful chronic illness, like fibromyalgia.

90 percent of serotonin is made in our gut. 

When it comes to moods, fear and anger are what author Julia Ross, of The Mood Cure, calls “low-serotonin-style negative moods”. Feeding your emotional centers with foods that promote serotonin help physical and mental health. 

These are foods that are rich in tryptophan, which is a building block of serotionin. Examples are:

• Pineapple

• Eggs

• Tofu

• Salmon

• Nuts and seeds

Ever have a migraine and throw up? People who vomit when they have a migraine often report the headache lifting. The process of vomiting seems to stimulate your blood level of serotonin, and with that, increased intestinal motility.

It stands to reason to support your gut.

There is some evidence that those with gastric health issues have a higher incidence of migraine and vice versa. In fact, one study connected migraine and IBS or irritable bowel syndrome as the most common condition.

Why would that be?

When the GI tract is inflamed, the membrane becomes semi-permeable. That is, by products of gut bacteria, called lipopolysaccharides enter the bloodstream and one of the responses could be migraine.

Take the time to tune in to your body , and your hedaches. Besides keeping a food log, you can also log stress, and emotions as well.

Take note if you're also feeling nauseous, dizzy, sweaty with your headache. Are you just plain hungry?

Our body leaves wonderful clues to what we need, if we can slow down and pay attention.

We may not always have the answers, but slowing down is definitely important to our longevity, and quality of life.

Resources

1. Murray, M., The Encyclopedia of Natural Medicine, 3rd ed., Simon and Shuster 2012.

2. Allais, Gianni, et al. “Menstrual migraine: clinical and therapeutical aspects." Expert Review of Neurotherapeutics, vol. 7, no. 9, 2007, p. 1105+. Gale Academic OneFile, Accessed 13 Feb. 2020.

3. Kalidas, Kavita. "Migraines in women: fluctuating hormones play a role in migraines, making it important to consider hormonal milestones and factors when formulating a treatment plan." Contemporary OB/GYN, Aug. 2017, p. 12+. Gale Academic OneFile, Accessed 13 Feb. 2020.

4. Ross, J., The Mood Cure, The 4-Step Program to Take Charge of Your Emotions--Today

5. Aggarwal, Milan et al. “Serotonin and CGRP in migraine.” Annals of neurosciences vol. 19,2 (2012): 88-94. doi:10.5214/ans.0972.7531.12190210

6. Xie, et al. “Effects of Diet Based on IgG Elimination Combined with Probiotics on Migraine Plus Irritable Bowel Syndrome." Pain Research and Management, 2019, p. NA. Gale Academic OneFile, Accessed 13 Feb. 2020.