Migraines that occur a few days before or during a woman’s period are so common that they have a name, “menstrual migraines.” According to the Cleveland Clinic up to 70% of female migraine sufferers report a menstrual relationship to their migraine attacks (research link). And the Migraine Research Foundation reports that women suffer migraine attacks three times as often than men (study link).
Watch the video for this article above. It is a hoot!
Is estrogen the cause of menstrual migraines? Why are migraines often eliminated after menopause when estrogen levels are low? Why don’t men—who have less estrogen—have migraines as often as women? The answers may surprise you, and most doctors.
To find the answer to migraines—all migraines—we need to take a look at how estrogen and progesterone levels fluctuate during a typical female month.
Graph 1: Estrogen and progesterone levels during the menstrual cycle. (Source: PubMed 16618254)
On days one through five of the menstrual cycle (during menstruation), estrogen and progesterone levels are low, as shown in Graph 1 above. After menstruation these levels begin to rise. The dip in estrogen between days 12-17 is the most common time for ovulation, a window of opportunity for pregnancy. After day 22, both estrogen and progesterone levels plummet until day 26 and then take a sharp dive to the low levels measured at day one, during menstruation.
The graph shows that progesterone and estrogen are extremely low just before and during menstruation. Why are migraines most likely to happen during this time?
Graph 2: Estrogen, progesterone, and glutamate levels during the menstrual cycle. (Sources: PubMed 16618254, 20980684)
The red line in the Graph 2 above shows typical glutamate levels during the menstrual cycle. You can see that just before and during menstruation, when migraines are most likely to occur, estrogen and progesterone levels are low but glutamate levels are high. Glutamate is your primary neurotransmitter (it carries your thoughts) and has been a primary suspect in the hunt for the cause of migraine since the 1970’s. You may know glutamate best as the migraine trigger monosodium glutamate, also known as “MSG.”
Graph 3: The relationship between estrogen, progesterone, & migraine probability (Source: PubMed 20980684)
So low levels of progesterone and estrogen and high levels of glutamate trigger migraines. But wait, this doesn’t make sense. If low levels of estrogen and progesterone trigger migraines, then men—with low estrogen levels—would have more migraines (they don’t), and women with low estrogen levels after menopause would also have more migraines (and they don’t).
This next graph will clear up the confusion and explain why men—with lower hormone levels—have fewer migraines.
Graph 4: Glutamate and glutamate scavengers GOT and GPT in men vs. women (Source: PubMed 20980684)
Men consistently have more glutamate (with 211) than women (93-169). Excessive glutamate is a migraine trigger. However, men consistently have more glutamate scavengers GOT and GPT. It is well established that excessive concentrations of glutamate between neurons (termed excitotoxicity) (study link) are associated with stroke, bacterial meningitis, seizures, Alzheimer’s disease, and migraine with aura. GOT and GPT scavengers have proven to reduce glutamate levels as well as reduce the levels of glutamate between neurons (study link). Men may have more glutamate, but they also have more of these glutamate scavengers that prevent a toxic buildup of glutamate between the cells.
Women have consistently low levels of those glutamate scavengers GOT and GPT, despite a large fluctuation of glutamate. This is the equivalent of attempting to double the amount of cars entering a tunnel without doubling the number of lanes. There will either be traffic or a crash. In the brain, this buildup of glutamate is known as excitotoxicity and is responsible for brain damage and migraines. Glutamate scavengers and glutamate transporters pick up the glutamate before accidents happen.
Estrogen and progesterone increase both glutamate scavengers (GOT and GPT) and glutamate transporters. Research is saying that high levels of glutamate are dangerous, but even more dangerous, is not having enough glutamate transporters (study link) and glutamate scavengers to pick up the glutamate between the cells. (study link) Stable levels of estrogen and progesterone will keep those glutamate levels down and prevent the toxic buildup of glutamate between the cells that trigger migraines and headaches.
Can you take a pill?
Birth control comes with a small increased risk of stroke and so does migraine with aura. However, despite the small combined risk, some women have successfully reduced their migraines by using birth control which keeps progesterone levels consistent throughout the month. Stable hormone levels may offer an explanation to the lack of migraines that most women experience after menopause, even though their estrogen levels are lower.
There is also an over-the-counter cream that migraine sufferers rave about called Emerita Pro-Gest Cream (product link). Anti-inflammatory medications such as Advil are often taken two days before and during menstruation to prevent menstrual migraines. Medications have mixed results and may come with side effects of more migraines. They are not typically a long-term solution to this very complex problem.
Why is the hormone and glutamate problem so complex?
Because of inflammation. It’s a buzzword in medicine because recent studies link inflammation to just about every disease and headache trigger. Inflammation interferes with the regulation of glutamate (study link). Migraine sufferers have increased inflammation levels, (study link) but those who eliminate the source of their inflammation and toxic glutamate levels will be able to reduce or eliminate their migraines.
What can I do?
The first step is to learn more about what raises inflammation and glutamate, starting with Part 2 of this article: “Pregnancy, a Migraine Cure?” Understanding exactly what triggers migraines and when migraines are triggered will help you pinpoint the triggers affecting your personal headache threshold. People who find the connection between their migraine triggers may be able to eliminate the root source of their migraines.
