Introduction

Migraine, a neurological beast with fangs of pain, is more than just a bad headache. It's a complicated web of changes in the chemistry of the brain. About 12% to 15% of folks around the world have to deal with this repulsive condition .

Almost a decade ago, an estimated 8.3% of Canadians (2.7 million) reported a migraine diagnosis by a health professional. Disturbingly, those numbers have only continued to climb since then.

Scientists are curious about how hormones, especially in women, team up with migraines. In this blog, we dive into the intricate complexity of hormones at various life stages, focusing on those pesky menstrual migraines. We'll also explore a potential fix known as Bioidentical Hormone Replacement Therapy (BHRT) .

Clinical trial data highlights the benefits of bioidentical estrogen (estradiol) as a part of HRT for menopause, to manage different symptoms in mostly vaginal or transdermal formulations (as patches or gels) instead of oral pills.

What is a Migraine?

A migraine is a severe, recurring headache often causing throbbing pain on one side of the head.It is typically characterized by severe headaches, nausea, and sensory sensitivity. It follows a kind of journey, influenced by both our genes and external factors.

Certain people possess a genetic tendency to experience migraines frequently. It makes them more susceptible to specific triggers. Common triggers include stress, hormonal shifts, changes in sleep patterns, and specific medications.

Triggers and heredity combine to cause migraines. One noteworthy event in the process is cortical spreading depression (CSD). Think of CSD as a wave of reduced activity in the brain cortex, possibly kickstarting the pain phase.

Now, the trigeminal nerve becomes active. Head and face sensations are controlled by this nerve. This activation causes inflammation in the nerves, releasing chemicals like calcitonin gene-related peptide (CGRP). The chemicals dilate blood vessels, which in turn causes more inflammation.

After that, the intensified pain signals make their way back to the head through the brainstem. This constant process is what brings about the pounding headache and the other symptoms.

Serotonin, a neurotransmitter, swings violently as migraine progresses. It affects perceptions of pain, appetite, and mood. Brain areas, such as the hypothalamus and brainstem, are crucial in coordinating various parts of a migraine attack. They work together to handle different aspects, adding complexity to the overall migraine experience.

How Hormones Affect Migraines in Women

Women are more susceptible to migraines and the effects differ depending on their age. Let's understand each of them.

Puberty

Estradiol (E2), released constantly during puberty, has remarkable effects on the brain. This is an important link between headache and menstruation.

It uses a variety of ways to protect the brain. It helps with learning and memory during the early years. E2 is an antioxidant that fights off free radicals to ease stress on neurons. Furthermore, E2 affects neurotransmitters, boosting serotonin levels to potentially relieve pain and mood symptoms associated with migraines. It also brings anti-inflammatory effects to the central nervous system to support overall brain health.

Despite its protective effects, estrogen's fluctuations during the menstrual cycle can impact migraine susceptibility in adolescents. A drop in estrogen levels before menstruation often results in more frequent and severe migraines.

The degree of susceptibility to migraines during puberty varies among individuals. Some may have increased vulnerability, especially during the premenstrual period. While others may experience headaches after menstruation.

Estrogen’s interaction with neurotransmitters such as serotonin and glutamate is crucial. When estrogen decreases before menstruation, it might boost signals from pain-triggering glutamate and reduce the calming effects of serotonin, playing a part in causing migraine attacks.

Reproductive Years

Estrogen's fluctuations become more apparent in the reproductive age. As the days before menstruation approach, a notable decrease in estrogen levels can often kickstart migraines. Understanding how estrogen, serotonin, and nitric oxide interact sheds light on why period migraines happen.

The menstrual cycle period is essential in the reproductive years. Estrogen takes the spotlight during this point. It peaks around the middle of the cycle and then takes a sharp drop right before the period starts.

During this period, E2 plays a starring role, peaking and then dramatically falling, often sparking headaches with period. Progesterone, E2's partner, also rises, impacting pain sensitivity and blood vessels.

As the premenstrual phase approaches, the estrogen plunge becomes a significant trigger. This drop in estrogen reduces its protective effects on the brain, making it more susceptible to migraine triggers.

Frequent migraines in this period heighten sensitivity in the trigeminal nerve. This makes minor hormonal shifts more likely to trigger migraines. Imbalances in serotonin and glutamate further contribute to the pain and other symptoms.

Recent research suggests that nitric oxide (NO), a blood vessel regulator, may play a role in migraines and periods. The decrease in estrogen before menstruation might reduce NO availability, potentially leading to blood vessel constriction and triggering migraines.

Similar hormonal imbalance is found between drugs used for birth control and migraines.

Perimenopause/Menopause

Headaches and perimenopause or menopause have an important connection. During perimenopause and menopause, women experience significant changes in hormones. E2 gradually decreases but occasionally spikes. This disrupts the delicate hormonal balance established during their reproductive years.

Progesterone decreases during these phases. But, its effects are less pronounced than the decline in E2. Other hormones like androgens and thyroid hormones play a role in the complex hormonal changes occurring during this phase. Menopausal migraines differ for all. For some, they intensify in frequency and severity during perimenopause and early menopause. This may be attributed to the withdrawal of the neuroprotective effects of E2.

On the contrary, for other women, migraines may improve or even disappear entirely after menopause. This positive shift could be linked to stabilized hormonal fluctuations and reduced sensitivity to their effects. Various individual factors, such as genetic predisposition and environmental triggers, contribute to the diverse experiences women have with migraines during this phase of life. Beyond hormonal changes, other factors come into play in the migraine landscape during menopause. Alterations in serotonin receptors may impact pain perception and contribute to the susceptibility of migraines.

Central sensitization, which is an increased sensitivity in the pathways of the trigeminal nerve caused by frequent migraine attacks, can continue into menopause, even without hormonal triggers. Migraines can be brought on by sleep problems, which are frequent during this period.

Bioidentical Hormones and Migraine Treatment

Bioidentical hormones aim to mimic the body's natural hormones. The term "bioidentical" emphasizes that they are identical in structure to those produced by the body. Derived from plants, these hormones are similar to the chemical structure of estrogen, progesterone, or testosterone. They closely resemble the body's natural hormones.

Bioidentical hormone replacement therapy (BHRT) is used to add the hormones . The key idea behind BHRT is to stabilize estrogen levels throughout the cycle. These are usually administered through patches, creams, or gels to counteract the drop in estrogen.

BHRT also takes progesterone into account. It offers a customized approach by balancing both estrogen and progesterone, aiming to establish an ideal hormonal environment to prevent migraines.

Moving beyond hormones, BHRT influences neurotransmitters in the brain, such as serotonin and glutamate. By stabilizing estrogen levels, BHRT may enhance serotonin activity, reduce pain transmission and potentially improve mood, important factors in managing migraines.

Additionally, it could counteract excessive activity of glutamate, an excitatory neurotransmitter, which may decrease the hyperexcitability of neurons and lower the risk of migraines.

BHRT may also be beneficial in addressing trigeminal sensitization. The therapy's potential anti-inflammatory effects, achieved by stabilizing estrogen levels, may help control inflammation in the trigeminal pathway. This is crucial for reducing sensitivity and lessening the risk of migraine attacks.

If you're in Canada and interested in learning more about BHRT for migraine management, get in touch with a qualified S&H medical professional to discuss whether this treatment might be right for you.

Visit our BHRT service page to find out more and schedule a consultation.

Who Gets Hormonal Headaches?

Understanding genetic influence in migraines is crucial. Rather than being predetermined, there's a predisposition, meaning a likelihood influenced by genetic variations.

Certain changes in genes linked to estrogen metabolism (like CYP17A1) and receptor sensitivity (such as the serotonin transporter gene, 5-HTT) can make individuals more susceptible to hormonal headaches.

These genetic tweaks can essentially lower the threshold, making headaches more likely. It's not just about estrogen; genes also impact other pathways in the brain involving neurotransmitters like glutamate and dopamine, adding complexity.

Family history, while not a guarantee, serves as a clue; if migraines run in the family, there's a higher genetic risk of experiencing hormonal headaches.

Estrogen's rhythmic fluctuations, especially during the menstrual cycle, can trigger headaches, particularly during the premenstrual dip. Progesterone plays a supporting role, influencing headache susceptibility, and some studies suggest higher progesterone levels might contribute to headaches in certain individuals.

Importantly, the impact of hormonal ups and downs on headache vulnerability isn't the same for everyone. It varies widely among women, underscoring the intricate interplay of genetic factors and hormones.

Moving beyond genetics and hormones, other factors come into play. Excess body fat, as in obesity, can disrupt hormonal balance, potentially increasing estrogen levels and heightening the risk of hormonal headaches.

Chronic stress adds another layer to this symphony, dysregulating hormones and neurotransmitters, becoming an additional trigger for hormonal headaches. It's not just internal factors; external elements matter too.

Sleep disturbances, certain foods, and medications can also contribute to triggering headaches, especially in those who are susceptible.

Preventing Hormonal Headaches Naturally

Looking beyond just using medications provides a more complete strategy. Embracing natural methods can serve as powerful allies in both preventing and alleviating these challenging episodes. Here's a breakdown:

• Aim for 7-8 hours of sleep with a consistent sleep schedule. As part of the bedtime routine, wind down with calming activities. Good sleep contributes to hormone regulation and helps in reducing stress.
• Deep breathing, yoga, and mindfulness meditation also calm the mind.
• A balanced diet supplies essential nutrients for overall health. It should be full of fruits, vegetables, whole grains, and lean protein.

Remember, these natural approaches are most effective when combined with guidance from a healthcare professional. They can tailor a comprehensive plan, including lifestyle adjustments, dietary changes.

Conclusion

Understanding migraines involves looking at the complex interplay of neurobiology, with a focus on hormones. BHRT shows promise in managing migraines by addressing hormonal imbalances.

A comprehensive approach that considers genetics, hormones, and the environment offers a more detailed understanding. This approach can pave the way for personalized therapeutic strategies, benefiting individuals dealing with menstrual migraines.