Let’s Chat About Headaches & Hormones

Do you suffer from headaches? Did you know there is a connection between headaches and hormones? In this Let’s Chat blog, I’ll help you understand the different types of headaches women experience and how fluctuating hormone levels can influence headache patterns. I’ll also discuss possible treatments for headaches, give you five tips to help stop them before they get unbearable, and leave you with five questions to ask your healthcare provider.

Sorry, honey, I have a headache

You may be wondering why a women’s health expert cares so much about something as common as a headache. The answer is quite simple: A headache is one of the most common reasons women visit their primary care physician, and headaches are much more common in women than men. Not only are headaches painful, but they can also affect your quality of life. Even more disturbing is that headaches can take up to three days (or more) to go away, often resulting in missing family events, calling in sick for work, and not feeling like exercising or having sex.

Joan’s story

I often see patients who come in for headache issues, including many women who have never suffered from headaches in the past. One of my patients, Joan, came in for exactly that reason. She had been experiencing several perimenopause symptoms, was having irregular periods, and had been getting headaches about three or four days before each period. Joan also explained that her mom had suffered from migraines, and she was afraid the same thing was happening to her.

I tried to calm Joan’s fears and let her know that many women suffer from headaches, especially during perimenopause. In order to help Joan understand why she started getting headaches, we first talked about what a headache really is. A headache is an activation of nerves and blood vessels in our head, with the blood vessels constricting and dilating. During perimenopause, many women experience a rapid drop in hormones a few days before their period. This sudden drop can cause a headache to occur before each period. Joan realized this was probably what was happening to her.

The good news for Joan was that adding extra estrogen during the few days before her periods was a good option and would likely solve her problem.

Types of headaches

It’s important to note that not all headaches are the same, and there are differences between each one:

• Migraine—This type of headache feels very “throbby” and is usually on one side of the head. A migraine can become overwhelming very quickly, and many people suffer from sensitivity to light and sound when they have a migraine.

• Tension—A tension headache usually causes pain all around the head, not just on one side. This type of headache doesn’t typically cause sensitivity to light and sound. A tension headache can be occasional or chronic and continue to get worse over time.

• Cluster—This type of headache is very different from tension or migraine headaches. A cluster headache is typically on one side of the head and the pain is severe, so severe that it can wake you up in the middle of the night. It is very rare, and you will probably know if you are having one because of the intense pain.

Headache triggers

So, now that we have talked about the different types of headaches let’s look at the triggers that can cause them to occur. This list is by no means exhaustive, but it includes the main triggers that most women talk about:

• Dehydration
• Sugar (high or low blood sugar)
• Stress
• Wine
• Chocolate
• Caffeine (can also be a treatment)
• Weather/change of seasons
• Altitude
• Drop in hormones

Headache treatment options

Now that we know what can trigger your headaches let’s discuss the treatments for each type.

Tension headache treatments

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin.
• Stronger medications like narcotics, although these are only prescribed in severe cases.
• Physical therapy, involving stretching and massaging.
• Trigger awareness (identifying the triggers before the headache gets really bad).

Migraine headache treatments

• Triptan drugs.
• Blood pressure medicines used for lowering blood pressure (there are side effects).
• Avoiding triggers like dehydration, sleep deprivation, wine, and stress.
• Drinking lots of water, having a cup of coffee, or taking a combination of acetaminophen and caffeine drug when you first feel the headache coming on.
• Steroid infusions (ordered by a neurologist).

Cluster headache

• Triptan drugs
• verapamil
• caffeine
• (all under the guidance of a physician)

When is my headache more than just a headache?

Sometimes a headache can be more than just a headache. Here are some danger signs that might warrant a CT scan to make sure there isn’t something else going on. You should contact your healthcare provider about setting up a CT scan if your headache is severe and you:

• Have a fever accompanied by the headache.
• Have a personal history of cancer.
• Are experiencing a neuro defect (such as paralysis) accompanied by the headache.
• Are over 50 years old and experiencing new onset of headaches.
• Are experiencing increasing headache pain with sneezing or changing positions.
• Are pregnant and suddenly experiencing headaches.
• Have an autoimmune disease.
• Are having retinal aura (part of your vision is blocked), especially if you are taking a synthetic oral estrogen.

Of course, it’s always best if you can stop your headaches before they get out of hand.

Five tips to follow:

1. Think about your headache triggers—If you feel a headache coming on, think about what typically triggers your pain. Are you under unusual stress? Are you staying hydrated? Are you going to start your period in a few days? Are you getting enough sleep?
2. Map the timing of when your headaches occur—If you start tracking the timing of your headaches, you can be better prepared before the pain starts and know what you need to do. Keep a journal and write down every time you have a headache, including any triggers that may have contributed to your pain.
3. Go back to the basics—I talk about the Seven Essential Elements of Daily Success (SEEDS®) all the time! Make sure you are following these every day, and if you’re not, you need to start. It’s also important to track your menopause symptoms. I have created something called the Menopause Transition Scale (MTS) to help you track each one.
4. Think of your headache as a gift—Don’t hate me for saying that! Here’s what I mean: If you are having headaches because of things like not handling stress very well, not getting enough sleep, and not eating a healthy diet, look at the headaches as a wake-up call to work on the triggers before they lead to a headache.
5. Prepare with a plan—If you know you’re going to have a long day and won’t have much time to grab breakfast or lunch, make sure to bring plenty of water and healthy snacks with you. This can help you avoid getting dehydrated (a trigger) or eating snacks like chocolate (another trigger for some people).

Five important questions to ask your healthcare provider:

1. What is my phase of ovarian function? Knowing which phase you are in—reproductive, perimenopause, or menopause—can help determine why you are getting headaches and when you are more likely to get them. If your healthcare provider isn’t comfortable talking about this topic, find one who will. A Certified Menopause Practitioner (CMP) specializes in midlife and menopause, and you can find a list of CMPs at menopause.org.
2. What type of headache do I have, and do I need testing or a referral? Knowing which type of headache you have—tension, migraine, or cluster (very rare)—can make all the difference when it comes to treatment.
3. Can we discuss triggers and how to treat them? Discussing your triggers with your provider can be very helpful. He or she might have other patients with similar triggers you are experiencing, which can be very helpful in finding solutions.
4. What are my treatment options? What are the pros and cons of each of them? Are there over-the-counter prescriptions that I haven’t thought of? If you travel quite a bit and know that pressure changes often bring on headaches, you want to make sure you have prescriptions readily available if you need them.
5. Who should I call if my headache gets out of hand? You want to make sure you can get in touch with someone (nurse, doctor, PA) if you are feeling like your headache is going from bad to worse. Find out what type of protocol the office uses to help you figure out what to do in those situations.

At true. Women’s Health, we are happy to help you with your headache issues. We work with other physicians, including neurologists, to help figure out what is going on and work together to find solutions that work for you!

By Dr. Diana Bitner