Hormones play a significant role in a wide variety of bodily functions, including how we experience pain. For people who suffer from migraines, understanding the relationship between hormones and migraine headache symptoms can be a game-changer. While hormones like estrogen, testosterone, and cortisol are often associated with specific biological sexes, fluctuations in these hormones can affect migraine risk in people of all genders. Understanding how your endocrine (hormone) system works — and what throws it off balance — can help people who suffer from migraine decrease the severity and frequency of symptoms.
Here, we'll explore how hormones can influence migraines, including how hormonal medications can affect migraines, and review both natural and medical strategies that can help balance hormones. We'll also talk about how Evidation's MigraineSmart tool can help you track your migraine symptoms, helping you to understand and avoid triggers.
How hormones influence migraine in all genders
Hormonal fluctuations are major drivers of migraines, particularly for those who experience regular hormonal changes due to menstrual cycles, pregnancy, perimenopause, menopause, or gender-affirming treatments. Hormones don't only affect women or people assigned female at birth (AFAB). Everyone produces estrogen, testosterone, and cortisol, and imbalances can trigger headaches and/or migraine in anyone. People assigned male at birth (AMAB) can also experience migraines related to testosterone dips or elevated cortisol levels, especially if they're experiencing high levels of stress or dealing with certain hormonal disorders.
Estrogen, testosterone, and cortisol: key players in the development of migraine
Even slight fluctuations in major hormones — including estrogen, testosterone, and cortisol — can trigger migraine attacks for some.
Estrogen
Estrogen's role in the development of migraine is well-studied. The hormone regulates serotonin, a neurotransmitter that plays a central role in migraine. When estrogen levels drop — such as before menstruation, during perimenopause, or after childbirth — serotonin levels also decline, increasing the likelihood of a migraine attack.
This is why many women report migraines just before getting their period. During perimenopause and menopause, estrogen levels can fluctuate unpredictably, making it difficult to pinpoint migraine triggers. Some women find that they experience relief from migraines during pregnancy due to maintaining higher levels of estrogen while pregnant, only to have them return after they give birth.
Testosterone
Testosterone has been shown to have a protective effect against migraines. It appears to reduce a brain event called cortical spreading depression that is thought to precede the onset of migraine pain. Testosterone may also support stable neurotransmitter levels. AMAB individuals with low testosterone may have higher migraine frequency, and AFAB individuals with an imbalance of testosterone and estrogen may be more likely to experience migraine.
Cortisol
Known as the "stress hormone," cortisol is linked to migraine. Chronic stress can lead to cortisol dysregulation.
Abnormally high or low levels of cortisol in both AFAB and AMAB individuals may cause:
- Disrupted sleep
- Fatigue
- Increased inflammation
- Increased nervous system sensitivity
- Increased migraine frequency or severity
Hormonal medications and their impact on headaches
Many people take medications that influence hormone levels, sometimes for birth control, hormone replacement therapy (HRT), or gender-affirming care. These medications can either alleviate or exacerbate migraine depending on their formulation and the individual's hormonal sensitivity.
Hormonal birth control
For many AFAB individuals, oral contraceptives — known as birth control or simply "the pill" — stabilize estrogen levels and reduce hormonal fluctuations, which may lead to fewer menstrual-cycle-related migraines. Others may find that the synthetic estrogen in birth control pills triggers migraines or increases their severity. Migraine with aura (neurological symptoms that can cause visual, sensory, verbal, and motor symptoms) is an especially concerning issue for those taking birth control that contains estrogen, as both migraine with aura and estrogen-containing birth control can increase the risk of stroke.
Hormone replacement therapy (HRT)
HRT can be used to treat menopause symptoms or as a part of gender-affirming treatment, but may be problematic for people who experience migraine. Some people receiving HRT may find that it alleviates the severity or frequency of their migraine symptoms, while others may find the opposite to be true.
Other medications
Corticosteroids and other hormonal treatments can also influence the frequency or severity of migraine. If you take prescription medication and experience migraine headaches, it's important to talk with your doctor about whether the two could be related and how to manage your symptoms.
Hormone testing and diagnosis
If you suspect that hormones may be to blame for your migraines, hormone testing can help.
Hormone testing can measure levels of:
- Estrogen
- Progesterone
- Cortisol
- Thyroid hormones
Testing is typically done through blood, saliva, or urine, and may be recommended by your family doctor, a neurologist, endocrinologist, or reproductive specialist. Your care provider might also ask you to track migraine episodes alongside your menstrual cycle, stress levels, or hormone therapy to look for patterns and identify potential triggers.
Natural and medical strategies to balance hormones
Addressing hormonal imbalance may reduce migraine frequency or severity. Your healthcare provider may recommend a number of strategies, including lifestyle changes, supplements, and medications tailored to your individual needs.
Natural approaches
Holistic methods your doctor may recommend to balance hormones include:
- Stress-reduction techniques: Yoga, meditation, therapy, and breathing exercises can all help your body regulate cortisol levels.
- Diet and nutrition: Eating a balanced diet with plenty of fiber, omega-3 fatty acids, and hormone-supportive nutrients like magnesium and vitamin B6 can promote balanced hormonal health.
- Sleep: Consistent, high-quality sleep supports balanced cortisol and melatonin levels.
- Exercise: Regular movement helps to improve insulin sensitivity and may help to regulate estrogen and testosterone levels.
Supplements
In addition to lifestyle changes, your care provider may recommend certain supplements, including:
- Magnesium
- Vitamin B2 (riboflavin)
- CoQ10
- Chasteberry
- Ashwagandha and other adaptogens
It's important to always check with your healthcare provider before starting new supplements, especially if you take prescription medications.
Medical treatments
If natural methods don't provide migraine relief, your doctor might recommend medical options, including hormonal therapy, migraine-specific medications (like CGRP inhibitors), antidepressants, or anti-seizure drugs.
Track, learn, and understand your triggers with Evidation's MigraineSmart tracking tool
Migraines are intricately tied to hormones, and tracking your symptoms can be vital for effective treatment. At Evidation, our MigraineSmart tracking tool utilizes data you collect from wearable fitness trackers (and other health data) to help you understand patterns and triggers, allowing you to take steps toward fewer migraine days. Whether you decide to fight back against migraine through natural lifestyle changes, hormone therapy, exploring and managing your triggers, we're here to help. Click here to learn more and get started with Evidation and MigraineSmart today.
