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February 29, 2016

Are You Suffering From Menopausal Headaches?

menopausal headachesDo You Have Menopausal Headaches?

Probably not, if you are a man though a menopausal woman might give you a headache. But, for some women headaches become a way of life once they go through the change. Why is that? Menopause is characterized by a significant decrease in sex hormones and that decline needs to be considered in perimenopausal and post-menopausal women when they experience more frequent headaches. Menopausal headaches include migraine and tension headaches. And, what we might consider sinus headaches could be migraine and tension headaches in some women.

Hormones and Headaches

The two main sex hormones or what we traditionally think as female hormones include estrogen and progesterone. Women do produce and need testosterone or the so-called male hormone, too. Estrogen and progesterone tend to have opposing effects on the body one reason why it’s extremely important that they stay in balance with one another. Estrogen is a proliferative hormone meaning it causes tissue to grow. These proliferative effects are most obvious in the breast and endometrium of the uterus. Progesterone is anti-proliferative. Unopposed (or minimally opposed) estrogen increases the risk of breast cancer and endometrial cancer.

Estrogen and progesterone also have opposing effects on blood vessels. Estrogen causes vasodilation and progesterone vasoconstriction. Fluctuating hormones cause repeated fluctuations in the dilation and constriction of blood vessels that can trigger migraine headaches. It is not uncommon for menstruating  women to experience headaches during the first couple days of their cycle when estrogen and progesterone both fall. Changes in blood vasculature, though, are not the only cause of migraines which have other triggers.

As women age they first witness a decline in progesterone usually beginning around age 35 and then later estrogen. This decline in progesterone relative to estrogen is frequently associated with migraine headaches. In addition, progesterone is a calming hormone as it stimulates GABA receptors in the brain just like anxiety drugs like Xanax and Valium. When progesterone levels fall some women become more anxious increasing their risk of tension or stress related headaches. That’s another mechanism by which hormones contribute to headaches in women.

During the perimenopausal phase hormones can fluctuate from day-to-day one reason women sometimes feel like they are on a roller coaster or merry-go-round. Once hormone levels are consistently low women may find that the frequency of their menopausal headaches decrease or even cease.

Treating Menopausal Headaches

Obviously if deficiencies in sex hormone contribute to menopausal headache we can expect hormone replacement therapy especially using bio-identical hormones to help prevent and treat them. Non drug treatment options include relaxation techniques, dietary changes eliminating sugars, artificial sweeteners, and eliminating excessive caffeine consumption, acupuncture, and biofeedback. It’s important to have a thorough physical examination to rule out causes of headache like sinus issues and cervical problems in addition to more serious causes like aneurysms and intracranial lesions like brain tumors.

Hormone therapy may worsen headaches initially again because of fluctuations in hormones. The body gets somewhat used to low levels of hormones and then levels are suddenly elevated with replacement therapy. If that happens smaller doses of hormone replacement should be considered and increased gradually if needed.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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