Many factors contribute to the onset of a migraine for both men and women, including family history and age. Women, however, often notice a relationship between headaches and hormonal changes. These are some of the topics that are discussed on the second episode of a six-part podcast series Beyond Migraine. 

The second episode in the series, which is brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland, is centred on the role of hormones in the onset of migraine attacks. Dr Mary Kearney, a GP with a special interest in migraine and co-author of The ICGP Migraine Quick Reference Guide is joined by Anna Daly, Virgin Media, TV presenter and businesswoman.

Linking hormones to migraines

It can take a very long time for those who experience migraines to figure out what their  personal migraine triggers are, and it is no less obvious for those experiencing hormonal migraines. Anna Daly admits it took her years, “I think I only realised they were migraines in the last couple of years, as headaches for me were not really a regular thing, but as I went through my teenage years, I started having more frequent headaches and it took me quite a long time to create some kind of a correlation and to realise that the headaches were linked to probably the first and the last day of my menstrual cycle”.

“I’m envious of people who can pinpoint the exact feeling of a migraine because I’m never really sure. Is this a period headache, or is this a migraine? Do I take a paracetamol for this, or do I go straight to the migraine tablets that I’ve been prescribed as soon as possible to get ahead of the migraine?”, Anna added.

This is unsurprising to Dr Kearney as a migraine expert. She explains that, particularly for those who experience migraines but don’t have a family history of it, it can be incredibly difficult to be able to distinguish a migraine from a tension headache, car sickness, a typical menstrual headache, or something else.

Being prepared when you visit your healthcare professional is something Dr Kearney recommends. You should track your migraine. “A migraine diary is absolutely essential and now there are apps where you can track your symptoms on your phone and tracking your symptoms encourages you to look at precipitating factors which you can discuss with your healthcare professional to help figure out the triggers for your migraine”.

Treatment

Once diagnosed – how is a migraine treated? When should medicine be taken? This is up to the individual, says Dr Kearney. Mild migraines involve a throbbing pain above the eye and might motivate the person experiencing the migraine to go to bed if they could. According to Dr Kearney, at this point you should evaluate your pain from one to ten. If the pain is greater than five out of ten, the migraine treatment needs to be taken. If the pain seems less than that, change something in your environment – go outside for fresh air, drink water, eat something.

When it comes to menstrual migraines, however, according to Dr Kearney, these are the most difficult kind to treat. “Affecting seven to 14 per cent of people, those experiencing menstrual migraines can get them at any point from two days before, to three days into a period. These women usually experience migraines at other times of the month, too. Some people experience purely menstrual migraine, where they don’t feel headaches at any other time in the month, but it’s been my experience that you have people who might get a few headaches at other times of the month and then they get the headache at the period time”, said Dr Kearney.

It is sometimes difficult to see the wood for the trees when trying to understand the connection between hormones and migraine, Dr Kearney’s experience has taught her that when living with migraine you first of all need to try and get the migraines under some sort of control and then maybe look at the hormones, because if you try to do it the other way around, it doesn’t work. According to Dr Kearney, “you’ve got to look at all the other trigger factors. Am I drinking enough? Am I eating enough? Am I getting enough sleep? Am I putting myself under too much stress? Am I getting up at five o’clock in the morning for a flight to London and a meeting at nine o’clock? Am I rushing around? If you’re doing that, you’re really doing too much and then if you have a period on top of all that, then you’ll get a more severe migraine. You can try and regulate the hormones but if you don’t look at the other trigger factors and precipitating events, doing anything about the hormones won’t work.”

The emotional fallout

Anna experienced debilitating hormonal migraines while pregnant, causing her to drop out of important social plans – which to her, made it even worse. “I remember really looking forward to a girly spa break. I was heavily pregnant, but I was excited about being part of it. I think I was in the hotel for an hour and suddenly, I felt the headache come over me. I spent the rest of the day in the bedroom while everyone was off enjoying themselves. The following day, I still couldn’t really take part, I couldn’t take any painkillers, obviously being pregnant.” The frustration of a migraine occurring and having to disappoint people is one of the worst things about experiencing migraine. Anna goes on, “There’s a sense of not wanting to let people down. You feel really disappointed in yourself. You almost try and hide it a little bit. When people say, do you still have that headache, you’re almost embarrassed by saying, yes, I do.”

Will hormonal migraines ever subside?

According to Dr Kearney, “for most women migraines improve in pregnancy because the oestrogen level rises during pregnancy, there are some people who do suffer really badly during pregnancy, but they are in the minority, particularly on the first pregnancy. I generally say to people, be prepared. Have your partner detailed about how to look after you”.

“Also, with the onset of menopause, it is possible that a person’s migraine attacks might lessen – but it’s also possible that they might increase. Such is the unpredictability of hormones”, according to Dr Kearney. “For some people they can improve – for others, in the early forties, it’s possible to get migraine for the first time. If the cause in that case is the menopause, it is most likely occurring in the peri-menopause stage when the oestrogen is fluctuating. The fluctuating oestrogen is really the problem. So, once the menopause comes and the hormones level out, the chances are migraines will reduce in regularity.”

You can listen to the Beyond Migraine episode featuring Dr Mary Kearney and Anna Daly here.

The series can be streamed via the Migraine Association of Ireland website as well as wherever you listen to your podcasts.

If you experience migraines during hormonal changes, speak to your GP. For more information about migraines, visit www.migraine.ie.

People living with migraine can also check out Life Effects. Life Effects is an initiative shaped by patients, for patients. It explores the latest science and thinking around your condition, it contains tips and patients share stories about the reality of living with chronic conditions. Find out more about migraine on lifeeffects.teva/eu/migraine.

This article is part of a sponsored series linked to each Beyond Migraine podcast episode brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland. The Beyond Migraine podcast is supported by funding from Teva Pharmaceuticals Ireland. Speakers have received an honorarium for their contribution to the podcast.