15 Aug Hormones and Headaches
There are multiple types of headaches which are caused or influenced by hormones. Migraine headaches, of which there are several subtypes associated with the menstrual cycle are the most common. Tension type headaches are also affected by hormones. Also, cluster headaches have a hormonal component. The first 2 types are primarily a female condition, while cluster headaches are primarily male.
For women, migraine headaches can occur at various times of the cycle. True menstrual migraine occurs without an aura and at the perimenstrual time between 2 days prior to 3 days after menses. Menstrual-related migraine with an aura can occur at any time of the cycle and is associated with a greater risk of cardiovascular events like stroke. For about 60% of women, the biggest trigger for the migraines is the fluctuation in hormones related to the menstrual cycle. One of the theories about migraines is that they occur in response to falling levels of estrogen with the largest decrease coming at the time of menses. However, anything which causes the hormone levels to fluctuate can cause the headache. The severity of the headache is associated with the degree of shift in hormones, not just the change itself. However, it appears that the situation is not that simple, with other hormones playing a part in the process.
At menarche (the beginning of menstruation), sex hormones cause permanent changes in the brain and 53% of girls report some type of headache at this point. Most of these early cycles are anovulatory, so not much progesterone is produced. Migraine with Aura is more common at this young age until establishment of a normal ovulatory cycle and the resulting balance with progesterone reduces them. Then migraine without Aura becomes more common and is mostly a true menstrual migraine occurring as discussed above in the perimenstrual time. The peak age of migraines in women is between 35 to 45 years of age, with 25 to 30% of women being affected to some degree.
Other hormones associated with migraine headaches are progesterone and testosterone. The use of progesterone for migraines is primarily to modulate the effects of estrogen by preventing too high a level of estrogen before it declines to cause the migraine. One study showed that implanted testosterone pellets reduced migraines by over 90% and deserves more study.
Another consideration is that supplemental hormones in contraceptives or in post-menopausal Hormone Replacement Therapy can be a factor in both causing the migraines and in treating them depending on the specific conditions.
Tension-type headaches are less studied than migraines, but do occur more often in women than in men. The most common risk factors are stress, fatigue, and sleep disturbance. Especially during the perimenopause these symptoms can cause or worsen the tension-type headache but there is also a correlation with hormone fluctuations common during this time.
Cluster Headaches, unlike migraines and Tension-type headaches are primarily a male condition so it might be thought that high testosterone levels are the cause but it turns out the opposite is true. A small study revealed that of 9 patients (7 male and 2 female) with Cluster headaches all of them had low testosterone levels. Supplementation with testosterone proved helpful in all of them.
If you suffer from a headache of one of these types, we see that hormones are very involved in the process and that this provides an opportunity to treat or prevent them.