Could This Be The Real Reason Women Struggle More With Migraines?

I started struggling with migraines in the beginning of college, which was about the same time I was diagnosed with PMOS (recently renamed from PCOS). I had never had a consistent menstrual cycle, so I was hopeful that starting an estrogen birth control pill might regulate my cycle and ease my migraine symptoms.

Within about a week of starting the estrogen, I noticed a sharp increase in my migraines. I didn’t want to believe that the hormones were causing the pain, so I searched for other answers. I minimized triggers like stress, long hours at the desk, and strenuous exercise, but with no avail. 

The increase in severity and frequency in my migraines was so significant that I stopped taking the estrogen pill within two months. Immediately after stopping, my migraines subsided to normal level. 

I was so confused, as my friends who also struggle with migraines had noticed that birth control had no effect, or even alleviated some of their symptoms. When I asked my neurologist about it, she told me that women with migraines have various responses to birth control that medicine ultimately can’t predict. 

Data shows a higher frequency, duration, and severity of migraine attacks in women. Globally, 20.7% of women struggle with migraines compared to just 9.7% of men. 

However, this gap doesn’t emerge until after puberty. 

“Migraine is pretty much equally prevalent in boys and girls until adolescence. During the hormonal transition of adolescence, the prevalence of migraine in young women spikes up,” explains Andrew Charles, M.D, a professor and director of the UCLA Goldberg Migraine Program. 

Women experience this increase in migraines throughout childbearing years, he says, but some women experience improvement after menopause. 

When women have consistent menstrual cycles, they are sometimes able to notice a specific time of the month where they are experiencing migraines. If a consistent pattern emerges between migraines and a woman’s cycle, neurologists often consider them “menstrual migraines,” and treat them accordingly.

“If women have primarily perimenstrual migraine, then we may do what we call short term prevention,” Charles explains. “We don't necessarily give people something everyday, but rather have them take it situationally, based on the timing of when an attack could occur.” 

However, this becomes much more challenging to figure out if this association between hormones and migraines exists when women don’t have regular cycles.

One of the reasons I was excited to see if birth control could help regulate my hormones, and possibly my migraines, is because my lack of a predictable cycle never allowed me to understand how the two might be connected. 

“What we find when we think about estrogen and brain health is that things are a bit more complex than we thought would be. And that is kind of a tough message,” says Tallie Z. Baram M.D., Ph.D, a distinguished professor of neurology at the University of California, Irvine.

Science can’t predict each woman’s unique reaction to oral contraceptives because no two women have the same hormone levels or migraine triggers. 

For me, the increase in estrogen from my oral contraceptive increased the frequency and severity of my migraines. However, if you notice that the monthly drop in estrogen before menstruation, or the spike in estrogen that occurs right before ovulation, are clear triggers for your migraines, then the hormonal consistency birth control creates may be helpful. 

“Sometimes birth control can be helpful to kind of just level off and have a certain amount of hormone as opposed to that fluctuation,” Khan explains. “It's not usually the first line therapy, unless we can really kind of hone in that hormones are really the only thing that's affecting migraines.”

Birth control may also affect your migraines differently over the course of your lifetime. Factors like stress, sleep, exercise and nutrition can all affect both hormones and migraines, and they all change throughout a woman’s lifetime.

Baram has a slightly different take on why fluctuating levels of estrogen might cause migraines, and it has to do something else women have a lot of: stress. 

When it comes to migraines, Baram says “Data suggests that the combination of high estrogen levels and stress is not great.” 

Baram recently conducted a study in mice1 that revealed high levels of estrogen appear to put the brain in a more "open," flexible state (called permissive chromatin), which makes the brain more susceptible to stress. Female mice in a low-estrogen phase were actually more resilient. 

“Each one of us needs to figure out what her triggers are and how that interacts with sex hormones, and then work with her doctor to find the best medicine or therapy for her,” Baram says.

There are lots of supplements people use to treat migraines, but the only one Charles finds to be effective is magnesium.

If you notice that you’re consistently experiencing migraines at a specific time in your cycle each month, a short-term, targeted migraine therapy could be an option to consider with your doctor.

If you can’t seem to keep track of your cycle, or notice that it is changing significantly month to month, it may be worth having a conversation with your doctor about taking a birth control pill to regulate hormone levels.

No one study will be able to figure out how every woman with migraines may react to an estrogen birth control pill, just like no one study can predict how every woman’s menstrual cycle will change throughout their lifetime.