What to do About Your Menstrual Migraines
According to the National Headache Society, women suffer from migraines three times more frequently than men. Roughly 60% of these women have menstrual migraines. The research is showing a huge link between estrogen fluctuations and your headaches. Many of us are aware that our hormones will change from day to day. Depending on where you are at in your cycle, you will either be estrogen dominant or progesterone dominant. Fluctuations are normal! A problem arises when these hormones fluctuate out of their normal fluctuation patterns. Meaning we have really high amounts or really low amounts of one hormone versus the other. Those high and low waves of estrogen specifically have been linked to menstrual migraines (1).
The normal female cycle starts with the follicular phase. In a nut shell, FSH is released from the brain to stimulate the growth of ovarian follicles. As the follicles mature they emit estrogen, causing an increase in estrogen levels in the body. This is where we should have more estrogen than progesterone. As more and more estrogen is secreted, FSH begins to decline and LH is released. Eventually there is a sharp rise in estrogen, a surge of LH, small burst of FSH and the mature egg is released. Now we are in the luteal phase. The corpus luteum surrounds the egg and releases small amounts of estrogen and dominantly progesterone.
The uterus is prepped for implantation and if it doesn’t happen, we shed the uterine lining and start all over. These are the normal fluctuations of our hormones. When there are extreme highs and extreme lows of a hormone we begin to see dysfunction such as migraines, PCOS, endometriosis, PMS and so on.
When estrogen is below normal, it is sometimes referred to as estrogen withdrawal and a migraine ensues. One of estrogen’s many jobs is to sensitizes serotonin receptors, which helps inhibit pain pathways (2). With low levels of estrogen the sensitization does not happen. This is why one of the common treatments for menstrual migraines is in the form of a serotonin agonist. The agonist acts on serotonin receptors and pretends to be serotonin, mimicking the same effects for decreasing pain pathways (3). Low serotonin will also activate the trigeminovascular nociceptive pathway (4).
The trigeminal nerve is the sensory nerve of the face. Activation and irritation of this nerve have been linked to migraines, especially migraines with an aura. Serotonin will inhibit the activation of the trigeminal nucleus and neuronal firing (3). Thus low estrogen, low serotonin sensitization, less deactivation of the pain pathway concerning the trigeminal nerve. It is important to note that the research is showing effects on the trigeminal nerve not only with low levels of estrogen, but high as well.
High levels of estrogen cause inflammation and neuropathic pain in the trigeminal ganglia (1). This is due to the relationship between estrogen and nitric oxide production. Increase in estrogen has been linked to an increase in nitric oxide (5). In response to this serotonin is released. However, nitric oxide can change serotonin from an active form to an inactive form (6), where it will be unable to have the dampening effects on the trigeminal nerve. As you can see, high levels as well as low levels of estrogen will cause menstrual migraines. These migraines are taking place primarily in the luteal phase of menstruation (1). Estrogen is naturally higher at the end of follicular phase and beginning of luteal phase and eventually slowly declines. Since extreme high and extreme low levels of estrogen can cause menstrual migraines, it is important to discover which one you have in order to be treated appropriately.
What are some causes for such extreme fluctuations of estrogen levels?
Well, for one we live in an estrogen dominated world. In fact, we are swimming in a pool every day of xenoestrogens – chemical endocrine disruptors that alter the normal function of estrogen. Where do we find xenoestrogens? In our make-up, skin care, lotions, cleaning supplies, plastics, food preservatives and coloring, insecticides and so much more. This is very taxing on our liver, the organ that is responsible for conjugating hormones so we don’t reabsorb them in a more toxic form. One of the best ways to make sure you aren’t exposing yourself to extra estrogens is to eliminate these products from your home. Go “green” as much as possible and check make-up, lotions, shampoos, conditions and so on for parabens and phthalates.
How we check for hormone levels at Integrative Brain and Body is through a saliva test. This shows the free forms of hormones, which are the active forms. If you suspect or know you have a hormonal issue there are some things you can do to help relieve your symptoms and get you on the right road to balancing your hormones.
1. Eliminate xenoestrogens.
The first thing is of course getting rid of as many xenoestrogens as you can.
2. Control blood sugar levels
The second is to control blood sugar levels. Rollercoaster blood sugar levels will cause stress on the brain where our hormone control tower is! This means eating breakfast, lunch, dinner and focusing on fats and proteins rather than carbohydrates. No more bagels or muffins for breakfast! If you are someone who is not hungry in the morning attempt a smoothie with a protein and fat base (like collagen powder and half an avocado) mixed with a small amount of berries. I have found that patients who do not like eating in the morning can handle smoothies.
3. Increase your cruciferous vegetables
Your liver, the organ that is responsible conjugation unneeded hormones as well as making the majority of your T3 thyroid hormone, loves cruciferous vegetables. Indole 3 carbinol, found in cruciferous vegetables, is known to help liver detox pathways (mostly hepatic phase 1).
4. Decrease inflammation
Your brain is very sensitive to inflammation. One of the best ways to decrease inflammation is to decrease the inflammatory compounds we are putting into our bodies. Once again that means food. Good quality fats, vegetables, and proteins should be the major focus of any diet.
In summary, it is abnormal fluctuations of estrogen that has been linked to menstrual migraines. These fluctuations have an impact on the trigeminal neuralgia, which is what causes the extreme face pain and has been linked to migraines with an aura. To determine where your hormone levels are a saliva test should be administered. Decreasing inflammation, stress on the body via blood sugar levels, decreasing your exposure to exogenous hormones and increasing liver function are all fantastic ways to help get you back on the road to hormonal balance.