The answer is yes……..and no.
Let me explain.
The timing of headaches and migraines around the start of cycle, and often mid cycle (of lesser intensity) is undeniabily related to your hormones.
However, the hormone profile of women who suffer menstrual migraine or headache is not significantly different to those who do not. So what is going on then?
We know that the common underlying problem in all major headache types including menstrual migraine/headache is an overactive brainstem. In particular it is the part of the brainstem that controls the trigeminal nerve (all the sensory information for the face and head - the area of pain of headaches) and the upper three cervical nerves.
This area is controlled by a chemical called serotonin - also know as the mood drug and is implicated in other conditions like depression.
Oestrogen plays an important role in the production of serotonin, and helps the body to use it.
When you hit the start of your cycle your oestrogen levels drop, taking serotonin with it. Now you have less ability to “turn down the volume” on the brainstem and the trigeminal nerves are “switched on” giving you a headache.
So your hormones are invovled because they stop producing the chemical that blocks out the overactivity from becoming a headache/migraine. The difference with non-headache sufferers is they don't have this overactivity so the lack of serotonin doesn't have the same impact.
Another way of visualising this is the brainstem being an empty cup. The activity is water in the cup. Most people start with little or no water in their cups, and it takes a lot of activity or “water” to overfill it and get a headache. Chronic headache and migraine sufferers have their cup near full all the time. It doesn't take much to overfill it. Some people I see with daily migraine have their cup constantly spilling over.
The effect of the drop in Serotonin is to not add water to the cup, but to lower the brim, or drop the height of the cup. It has become easier to spill or overfill and the result is your headache.
The second impact of the drop in Serotonin is that your blood vessels vasodilate or open wider. Not enough for them to directly cause referred pain of a headache, but enough that the vasodilation itself sends more information to an already overactive brainstem - more water in the cup.
Midcycle we see the same, but lesser thing - more oestrogen, increased serotonin, and a vasoconstriction - more water in the cup - but with more serotonin as well the impact is often less.
So why are these nerves in the brainstem overactive in the first place? In over 80% of cases the answer lies in the nerves coming from the upper cervical spine and dysfunction of the upper three segments of the spine.
In 80% of cases using very specific techniques, the typical pain of headache and migraine, including menstrual migraine can be reproduced, and eased with carefiully directed stress in the upper cervical spine - this not only confirms the neck as playing a role in your pain. In these cases treatment of the neck is indicated and has a very high rate of success.
If we can reproduce and ease the pain, it can be treated, and you can go on having cycles without the fear of being shut down by a strong headache or migraine.
Director and Senior Clinician
Melbourne Headache Centre
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