This is the first post in a series on solving migraines with a root-cause, functional medicine approach. Here we delve into four primary causes of menstrual and hormonal migraines, and what you can do for relief.
1. Reproductive hormone fluctuations
Often migraines are related to your menstrual cycle, such as premenstrual migraines. They can happen during other times in your cycle, when your hormones are fluctuating, like when your period starts or when you ovulate. They can also occur unpredictability during perimenopause, when your hormones are all over the place.
Often the hormone issue is estrogen dominance (too much estrogen relative to progesterone), which can contribute to cycle-related headaches. Estrogen dominance is natural during perimenopause, but for some women it’s more extreme, and triggers headaches.
What to do?
- Assess hormones with a blood test and/or the Dutch comprehensive hormone test, and get a natural medicine treatment plan.
- Acupuncture is highly effective for hormone balance.
- On your own, you can try vitex to support progesterone and Femguard for estrogen dominance.
- Bio-identical progesterone is an option.
2. Menstrual migraines
These happen during menstruation. At this time in your cycle, you have higher levels of inflammatory prostaglandins (PG) in your uterine lining. Women who get migraines during menstruation have been shown to have even higher levels of these PGs. Vitamin E is an anti-PG agent with a low side effect profile, and can effectively relieve headache pain and associated migraine symptoms. Research shows that 400 IU vitamin E for five days during menstruation can effectively reduce or prevent menstrual migraines.
What to do?
- A trial of 400 IU of a good quality vitamin E for five days during menstruation, for three menstrual cycles. If you feel better with an anti-inflammatory medication such as ibuprofen, which also inhibits PG, it’s likely this could help you.
- Omega 3 fats in a dose of 2 – 4 grams during menstruation.
3. Blood sugar and insulin fluctuations
Insulin is the hormone that rises when you eat sugar or carbohydrates (carbs). It drives sugar into your cells, so you can turn it into energy. Eating too many refined carbs or sugar causes rapid spikes in blood sugar, followed by surges of insulin to quickly move the sugar into your cells. Then your blood sugar levels drop.
Clinical low blood sugar (hypoglycemia) is blood glucose at or under 70 mg/dL. Symptoms are unpleasant, and include shaking, irritability, sweating, palpitations, and/or tingling. Hypoglycemia can trigger migraines. However, few women have true clinical hypoglycemia.
You may feel unwell simply because of the fluctuations of blood sugar and insulin that follow a meal too high in carbs. If you feel unwell or get a headache between meals, examine your last meal. Did it have enough fiber, protein and fat to slow down metabolism to carry you for four hours? Or, did it have too much refined carbs or sugar, causing blood sugar to spike and crash?
It’s a myth that everyone should eat every two to three hours throughout the day. This is simply not true. If your meal is sufficient, you should be able to go for four hours before eating again, or longer. So if you feel unwell or get a migraine, examine what you ate at your last meal.
It’s normal to need a snack when meals are far apart, or after exercise. Some women need a bedtime snack to prevent night or morning headaches from nocturnal low blood sugar.
If you need to snack between every meal, so that you snack several times per day, then you may have blood sugar and insulin dysregulation. If so, you should tackle this problem.
What to do?
- Eat enough at each meal to sustain you for four hours. Check that your meal has sufficient fiber (7-10 g or more), protein (4 ounces or more), and added fat if your protein is lean.
- Check that you aren’t overdoing carbohydrates, especially refined carbs, and sugar. Download this Carb Chart For Women to assess your needs, and this Net Carb Chart to learn about carb quantities in whole foods.
- If you go longer than four hours without a meal and need a snack, have one that includes protein and fat.
- Have a light snack before bed if needed to avoid nighttime or morning headaches.
- Find out if you have blood sugar and insulin dysregulation, with a simple blood test for fasting blood sugar, hemoglobin A1C, fasting insulin, and triglycerides. If you do have problems in this area, get on a program that includes diet and supplements tailored for you.
4. Stress hormone fluctuations
It’s probably no surprise that stress is a migraine trigger. Stress can flood your bloodstream with high levels of the fight or flight catecholamine hormones: dopamine, adrenaline, and noradrenaline. The adrenal steroid hormone cortisol can go up. These surges can trigger migraines.
What to do?
- Test your adrenal steroid hormones (cortisol and DHEA) levels and fluctuations with the Dutch adrenal test. Then work with a practitioner to get your HPA axis (adrenal-brain communication) in order. This will make a big difference, and help you be more resilient to stress.
- You can test your adrenal catecholamine hormones (dopamine, adrenaline, and noradrenaline) through the organic acids test, and get help with raising, lowering, or modulating these neurotransmitter hormones.
- Besides getting your hormones in order, you do the most important part: change your perception of stress and develop stress reduction and management techniques. Check out this post about healing from chronic stress.
Check out the next post on Migraines, Leaky Gut & Leaky Brain.
I welcome your comments and questions!