In their lifetime, 40% of women and 20% of men will experience migraine headaches. Up to 60% of female sufferers have headaches associated with menstruation. According to the International Headache Society, menstrual migraines without aura (a pre-headache visual, sensory, motor, or verbal disturbance) may begin two to three days after bleeding starts.

Potential Causes of Migraines

Possible triggers include a decrease in estradiol, release of inflammatory substances from the uterine lining, low magnesium, decreases in certain brain chemicals like serotonin and GABA, dehydration, suspected foods and insufficient sleep. Some migraine specialists believe that a decrease in estradiol levels is the most likely trigger.

Estradiol as a Possible Treatment Option

According to Dr. E. Anne MacGregor, raising premenstrual estradiol levels can help to avert or minimize the effect of these migraines. Maintaining estrogen in a range of 45-75 pg/ml may reduce the intensity and frequency of migraine headaches. Estradiol 1.5mg gel, applied six days prior to bleeding and continued through Day 2 of menses, has been shown to effectively decrease the number of migraine days in some women. Extending this time period beyond day 2 and tapering the dose may help prevent “withdrawal” headaches caused by stopping estradiol abruptly. Progesterone may also help decrease these headaches because progesterone helps regulate pain and pain perception through GABA receptors in the brain.