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Managing Migraines: Tips for Women Over 40

migraine statics by gender and trigger

Migraines affect women more than twice as much as men.  In fact, 70% of migraineurs are women!

And why is that? Yes you guessed right: our hormones!  A whopping 60-70% of migraines in women are hormone related. 

Any abrupt decline in estrogen makes women more vulnerable to developing migraine headaches. This typically happens before/during menstruation (can also happen just after ovulation around the middle of your cycle), during perimenopause, and after birth. 


We have estrogen receptors all over our body, and as I said before, we have a lot of them in our brain. And our brain doesn’t like fluctuations of estrogen: it wants it to be stable. So this is one of the main reasons for memory loss and brain fog in perimenopause, but it can also cause migraines, because it triggers contractions in your blood vessels that can set off migraines. They are triggered by an abrupt fall of estrogen levels. So you can imagine that during perimenopause, when our hormones go on that roller coaster ride, there’s a lot of fluctuations but especially towards the end of perimenopause, there’s a lot of highs and lows of estrogen and every time we get a high, the fall is too abrupt and can trigger a migraine.

There’s a lot of studies and research that point out low estrogen causing migraine headaches, however, what I have experienced myself and what I see in clients, is that it’s really about that fall of estrogen which always comes from estrogen being elevated before it falls off. 

female cycle and hormonal migraine

In fact, far more women suffer from the effects of estrogen dominance during and after the transition to menopause and that’s also due to a lack of progesterone:

When you are in your 40s, things don’t get easier as your ovaries (slowly) stop producing progesterone, estrogen (and testosterone). Progesterone and estrogen keep each other in balance and if your progesterone declines, not only do you have more anxiety, sleep issues and PMS, but it will also lead to an imbalance or too huge gap between these two hormones.

How much your estrogen levels fluctuate throughout your cycle very much impacts migraine headaches. 

How to know if your migraines are linked to your hormones?

The biggest indicator really is if your migraines always come just before your period or happen on the first days of your period. As I said above, they could also happen around ovulation, basically once your estrogen drops in the second half of your cycle.

Now, if you are already post menopause and are struggling with constant headaches, too low estrogen could actually be the root cause here.

For those who are curious, this is why and how it works:

The loss of estrogen has been linked to influencing magnesium concentrations, prostaglandin release (this means that you will have more inflammation), oxytocin, and serotonin, which influence our pain perception pathways. 

When your estrogen levels fall, it will also increase the susceptibility to prostaglandins, meaning you are more prone to inflammation. 


Hormone fluctuations are of course just one reason why you may be getting migraines, and often there’s several different triggers that will cause migraines:

  • Stress (drives neurotransmitter changes in the brain) 

  • Serotonin imbalance: when estrogen levels fall, you will also produce less serotonin and the sensitivity of triptan target receptors decreases (triptan drugs address this directly by affecting serotonin receptors). Low serotonin impairs normal blood vessel dilation.

  • Nutrient deficiencies:

  • Magnesium deficiency: it helps to keep your blood vessels responsive. Magnesium typically decreases along with estrogen in menopause.

  • Iron deficiency: A study suggests an association between iron-deficiency anemia, hemoglobin and serum ferritin levels and the incidence of migraine in females. 

  • Lack of other nutrients which are needed for healthy mitochondrial function (CoQ10, B2 (riboflavin) etc). Mitochondria are part of your cells and are responsible for producing energy. Mitochondrial function often declines with age, but can also be impacted by an unhealthy lifestyle. Any mitochondrial impairment in the brain likely leads to a deficit in mitochondrial energy, which in turn can be a migraine trigger. (Source)

  • Toxic burden based on toxins, chemicals, free radicals that we are exposed to daily and also byproducts that our gut bacteria can produce (read more here

  • Food sensitivities or allergies: can trigger a cascade of events that results in a migraine. This can include histamine-containing and histamine-triggering foods. Histamine itself triggers blood vessel dilation. 

  • Inflammation: Migraine and other chronic pain conditions have been associated with inflammatory diseases. That’s why prostaglandins play such a big role here. (Read more here). When your estrogen levels fall, it will increase the susceptibility to prostaglandins aka inflammation. This can cause inflammation in the brain by promoting the release of neuropeptides including CGRP. 

What can you do to manage migraines?

  • Reduce and (most importantly) manage stress 

  • Exercise to improve blood flow and support healthy blood vessels 

  • Identify and eliminate dietary triggers (use a journal to track them) 

  • Assess and balance hormones 

  • Eat a whole food diet that’s providing you with plenty of nutrients and keeps your blood sugar stable. 

  • Make sure you stay hydrated (coffee, tea, sodas, juices etc don’t count: you need to drink water or herbal teas)

  • Avoid food additives: they are common triggers for migraines, especially benzoic acid, monosodium glutamate (MSG), and tartrazine (yellow no5)

  • Support histamine breakdown: Histamine intolerance can result from a poor ability to break down histamine. Migraine sufferers are more likely to have higher histamine both during headaches and during times without headaches. Read more here. 

  • Dietary amines (e.g., tyramine) are chemicals that occur naturally, caused by bacteria that break down amino acids. They have been found to trigger migraines in some women. A combination of foods that trigger vasodilation is much more likely to cause a migraine than individual foods (e.g., red wine with cheese, olives and chocolate in the same meal). 

What can you do for hormonal migraines in perimenopause and menopause?

In perimenopause, you want to avoid those hormone fluctuations and tame that hormone roller coaster. 

In menopause, you’ll likely need to bring up your hormone levels overall. Both can be achieved with bio identical hormone replacement therapy

Research suggests that using estrogen therapy month over month reduces the frequency and intensity of migraines over time.  Women will often find a significant reduction in migraines between months 1 and 2, and then again between months 2 and 3 when used each month consistently.  

Although estrogne is the key hormone linked to migraines, you need to make sure that you have adequate levels of progesterone too. In any case you’ll never supplement with estrogen alone in order to keep that natural balance between estrogen and progesterone. 

Always consider as well that the more stress you are experiencing, the higher dose of HRT you’ll likely need in order to compensate for cortisol taking up all the space and lowering your sex hormone levels. 

If you would like to have a chat about how to get your hormones back on track, book your free clarity call here.


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