Causes and Treatments for Migraines and Headaches in Women

Headaches can be hateful things. Even the most common type of headache, a tension headache (mild to moderate pain that feels like a tight band), can strike out of nowhere for unknown reasons and put a damper on your day. Migraine headaches, which cause severe throbbing pain (usually on one side of the head) and other uncomfortable symptoms like nausea, vomiting, and sensitivity to light and sound, can be even more debilitating. They don’t just dampen your day, they can wreak havoc on your entire week.

While the medical community still has a lot to learn about the cause(s) of common headaches and migraines, it has identified certain factors that seem to play a big role in their formation, including stress, sleep, and hormones. In fact, fluctuating hormone levels, especially in people assigned female at birth, might be the most important factor when it comes to migraines.

Whether you get a tension headache every now and then or suffer from migraines on the regular, this article aims to bring hope to all headache sufferers looking for a little more information about preventing, treating, and managing headaches, especially when hormones are in the mix.

How Hormones, Stress, and Sleep Impact Migraines and Headaches

People assigned female at birth experience three times more migraine headaches than men, and an imbalance of hormones, especially estrogen and progesterone, might be to blame. The connection between hormones (chemical messengers in the bloodstream) and headaches is complicated. Too much estrogen seems to trigger migraines, but too little estrogen can precipitate this type of headache too. Many different factors can influence your susceptibility to getting “hormonal migraines’, including genetics and lifestyle, but there are certain (often predictable) scenarios that increase your risk.

• Periods: Women experience a dip in estrogen and progesterone just before menstruation, and this drop in hormone levels can lead to migraines.
• Pregnancy: Estrogen levels rise during pregnancy, and this change can cause migraine headaches.
• Childbirth: After giving birth, estrogen levels decrease, which can give rise to migraines.
• Perimenopause and Menopause: Decreasing levels of estrogen and progesterone during these phases of life can cause migraines.
• Hormonal birth control: While many people find relief when taking hormonal birth control, some women experience an uptick in migraines when starting or changing hormonal contraceptives.
• Hormone replacement therapy (HRT): HRT can have a similar impact on people. For some, this therapy triggers migraines. For others, it’s the magic bullet that makes migraines a thing of the past.

Stress is a well-known trigger for tension headaches and migraines. But it’s not the big changes in life we’re talking about. Instead, it’s usually the little ‘headaches’ of life that lead to actual headaches. Sitting in traffic. A big project at work. A to-do list that keeps growing and never seems to get done. All the racing around and racing thoughts can wreak havoc on your health.

When we experience everyday stress like this, our bodies involuntarily tense muscles, grind teeth, stiffen shoulders, and release chemicals that impact blood flow. It’s no wonder, according to studies, migraines occur most frequently in the morning.

Both too little and too much sleep can trigger tension headaches and migraines. Poor sleep quality and sleep disorders, such as insomnia or sleep apnea, are associated with an increased frequency of migraines. Restful sleep is crucial for regulating neurotransmitters and repairing neural pathways, which can influence all types of headaches. On the flip-side, sudden changes in sleep patterns (think jet lag or pulling an all-nighter) can initiate tension headaches and migraines.

Preventing, Managing, and Treating Migraines and Headaches

Managing headaches and migraines often involves a focused-effort to address the contributing factors head-on. This may include starting hormonal treatments (birth control), practicing stress management techniques (regular exercise, yoga, meditation), and improving sleep hygiene. Identifying and avoiding specific triggers and using preventive medications can also be part of an effective strategy to reduce the impact of headaches and migraines. Besides fluctuating hormones, stress, and poor sleep, here are a few other common triggers for headaches and migraines:

• Alcohol and caffeine
• Sensory stimuli, like bright/flashing lights, loud sounds, and strong smells (perfume, second-hand smoke).
• Physical strain, such as intense exercise and sexual activity
• Foods and food additives, like aged cheeses, processed foods, aspartame (an artificial sweetener), and MSG (a preservative).

Despite best efforts, sometimes headaches still happen. If you find yourself on the verge, especially if it feels like a migraine, here are a few quick steps that might help keep it under control:

• Taking a nap or resting in a quiet, dark room
• Putting a cool cloth or ice pack on your forehead
• Drinking fluids

If making lifestyle changes and avoiding triggers aren’t doing the trick, it might be time to try a pain-relieving or preventive medicine specifically designed to help with headaches.

• NSAIDs: These over-the-counter pain relievers (Advil, Motrin) are usually enough for tension headaches and can help if taken at the outset of a migraine too.
• Triptans: These prescription drugs (Imitrex, Maxalt) block pain pathways in the brain and are the go-to rescue medicine for migraine pain.
• Gepants: Calcitonin gene-related peptide antagonists is a newer group of medicines for migraines.
• Anti-nausea medicines: Often taken with a pain reliever, this class of drug helps with any nausea and vomiting associated with a migraine.

If one of these medications isn’t right for you, there are many medicines used “off-label” for migraine relief, including dihydroergotamine, blood pressure-lowering agents (beta blockers, calcium channel blockers), antidepressants, anti-seizure drugs (Topamax), and Botox injections that have proven to be both safe and effective for managing and treating migraine pain.

Headaches happen, and most of the time, they aren’t a sign of anything serious. Hormonal changes. Too much stress. Not enough rest. These are all things you and your provider can do something about. Some symptoms, however, can indicate something more significant and should prompt you to seek medical attention. These include: a sudden, severe headache that feels like a “thunderclap”; a headache with fever, stiff neck, confusion, seizure, double vision, and numbness or weakness; a headache that occurs after a head injury; a chronic headache that worsens after coughing, exertion, straining, or sudden movement.