Menstrual Migraines

migraine menstrual headache
Migraine Headache

Menstrual Migraines

Suffering from a migraine every month around the time of your period?  Likely there is a hormone imbalance contributing to these PMS headaches.  I have had women who had suffered with these every month for 16 years, who were amazed to find that their period could come and go without a migraine after naturopathic treatment.

What Causes Migraines?

There are a number of theories as to the origin of migraines:

  1. Serotonin imbalance
  2. Histamine – excess or intolerance
  3. Lack of B vitamins
  4. Lack of magnesium
  5. Muscle tension
  6. Hormone imbalance

What Can I do About Migraines?

The solution to migraines is to address some or all of the factors listed above, all of which can be done through naturopathic medicine.

Serotonin imbalance

Serotonin is a neurotransmitter that is produced in the brain, it is a chemical that the brain produces that influences how the brain works.  It is considered to be the “happy” neurotransmitter and it’s one of the key neurotransmitters addressed in people who suffer with depression.  The brain requires vitamin B6, magnesium and an amino acid called tryptophan to make serotonin.  Supporting these nutrients can sometimes allow the brain to rectify a serotonin imbalance on its own.

Histamine

Histamine is a substance released by white blood cells called mast cells.  It’s part of how the immune system defends you against viruses and bacteria, but excessive histamine can cause inflammatory conditions like allergies.  People with allergies will take anti-histamines to try to prevent histamine release or histamine binding to receptors.  Vitamins C and B6 are natural anti-histamines.  In the gut, we produce an enzyme that helps to break down histamine, called DAO.  Some people aren’t genetically programmed to produce enough DAO, for those people sometimes supplementing DAO helps.

Lack of B Vitamins

Vitamin B2, B5 and B6 supplementation have all been shown to help migraine sufferers.

Lack of Magnesium

Magnesium serves a dual purpose for those with migraines: it helps muscles to relax and helps calm down the nervous system.  Both B vitamins and magnesium are also essential to help the body cope with stress.

Muscle Tension

Tightness in the neck and shoulder muscles can compress nerves, cause misalignment of the spine (subluxation) and contribute to migraines.  Massage therapy, chiropractic treatment, proper posture, yoga, pilates, a more ergonomic work environment, acupuncture, craniosacral therapy and magnesium may all help with migraines that originate from muscle tension.

Hormone Imbalance

Menstrual migraines are obviously related to fluctuations in hormones or hormone imbalance. What has worked most effectively in my practice for these types of migraines has been enabling efficient phase I and phase II liver detoxification through supportive nutrients like pyridoxal-5-phosphate, 5MTHF, vitamin B12, indole-3-carbinol, calcium-d-glucarate, N Acetyl-cysteine, and magnesium.  Herbs like Vitex agnus-castus combined with vitamin B6 will also sometimes help in the event of insufficient progesterone production.

 

Estrogen Metabolism or Clearing Excess Estrogen

Sex hormones are produced in the body via the following assembly line:
Cholesterol —-> Pregnenolone —-> Progesterone —–> Androstenedione —-> Testosterone —-> Estradiol (one form of estrogen).  Estradiol is our end product and when there is the right amount of our end product, it’s the liver’s job to take any extra and break it down through a series of steps known as Phase I and Phase II liver detoxification. There are several ingredients required for successful breakdown and clearance of estrogen, as well as chemicals, pollution, pesticides etc. that can act like estrogen. We want to remove any excess estrogen and these waste products so that they don’t accumulate and do harm such as promoting reproductive cancers.

The first step in estrogen breakdown is conversion of estradiol to estrone. Estrone is then metabolised through Phase I liver detoxification (hydroxylation) into 2-hydroxyestrone. Cruciferous vegetables, flaxseeds, soy and rosemary supply substances like indole-3-carbinol that are necessary for this step to occur. The next step in estrogen breakdown is Phase II detoxification (methylation) which converts 2-hydroxyestrone to 2-methoxyestrone. This step requires vitamin B6, B12 and ACTIVE folic acid (5MTHF) to proceed. The active folic acid part is important as most folic acid from supplements is inactive. Some people have a defective gene that doesn’t allow them to process folic acid properly, so that they cannot make 5MTHF. This causes sluggish liver detoxification. There are 3 final procedures the liver can do to our 2-methoxyestrone to package it up for elimination. Glucuronidation requires glucaric acid, methlyation requires active folic acid again (5MTHF) and sulfation requires sulfur.

If any of these ingredients is missing, estrogen breakdown will be incomplete and estrogen, estrogen breakdown products and other waste like it, can build up in your system creating health problems like endometriosis, acne, fibroids, painful periods, hormone related cancers, heavy periods, infertility and other hormone imbalance conditions. In treating these conditions, I find it successful to provide (in the form of supplements) each component necessary for successful completion of phase I, phase II and the final packaging steps.

The typical benefits of enhancing estrogen metabolism this way include reduced risk of hormone related cancers, lighter periods, less cramping, less breast tenderness, reductions in fibroids, improved fertility, and clearer skin.

How Often Should I Do an Estrogen Detox?

That depends on the person and their particular symptoms, but for the average person, once per year.

Should Men do Estrogen Detoxification?

Yes!  Men produce estrogen as well and  excess estrogen and accumulation of estrogen like chemicals like bisphenol a, can bind to estrogen receptors in men and promote cancer such as prostate cancer.

Source: Medicine (Baltimore). 2015 Jan;94(1):e211 . Bisphenol a and hormone-associated cancers: current progress and perspectives.  Gao H1, Yang BJ, Li N, Feng LM, Shi XY, Zhao WH, Liu SJ.

Signs and Symptoms of Hormone Imbalance

How would you know if you had a hormone imbalance? Most of the women I see already have an inkling that something is out of balance by the symptoms that they are experiencing:

  • Hair loss
  • Acne
  • Irregular periods
  • Night sweats
  • Hot flashes
  • Infertility
  • Heavy periods
  • Painful periods
  • Fibroids
  • Ovarian cysts
  • Uterine polyps
  • Excessive facial or body hair
  • PMS
  • Premenstrual migraines

Most often they have already visited their family doctor who “checked their hormones” and told them “everything is normal” or offered them the birth control pill.

There are three main problems here:

  1. By checked their hormones, most doctors mean they’ve done a very superficial screening of hormones, LH, FSH, maybe estradiol and maybe progesterone, but often not measured on specific dates of the menstrual cycle that make the results clinically meaningful.
  2. When “everything is normal” even though you feel that hormones are imbalanced, it’s because the “normal” ranges for hormones are extremely wide and so even abnormal people fall into the “normal” range.
  3. Birth control pills only mask the existing hormone imbalance, they don’t correct it.

If you feel like you have a hormone imbalance, always ask for a copy of blood work results so that you can see exactly how extensive testing was and exactly where your results fall in the “normal” range (normal is always in quotes because lab ranges rarely refer to what is actually normal, it is more often an average of unhealthy people).  99% of the time you will find that either: a) only a very few hormones have been tested and/or b) one or more of your results were borderline.

Menstrual and Premenstrual Migraines

For clues as to what may be causing premenstrual migraines, we have to look at what is happening hormonally at that time. On Day 21 of your cycle, progesterone is hitting a peak and estrogen levels are starting to rise a little to come to a second peak around day 23-24. By about day 25, assuming you are not pregnant or on the birth control pill, both levels are starting to fall which is the cue to your body to release the uterine lining and have a period. The peak of progesterone around day 21 is thought to be protective against migraines. The drop in estrogen is also thought to be associated with migraines. In the women that I have worked with who had premenstrual migraines, what has worked beautifully is an approach that optimizes progesterone production and balances estrogen.

1. Headache. 2008 Nov-Dec;48 Suppl 3:S124-30. doi: 10.1111/j.1526-4610.2008.01310.x. pidemiology and biology of menstrual migraine. Martin VT1, Lipton RB.
2. Headache. 2006 Mar;46(3):365-86. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis–part 2. Martin VT1, Behbehani M.