Sydney Headache & Migraine Centre

Why is menstrual migraine not all about the hormones?

Menstrual migraine is a very common type of migraine felt in women. You may feel the migraine coming on at the start of your period where estrogen levels drop. You may feel it mid-cycle where estrogen levels spike. One thing is for sure – menstrual migraines are those which are typically felt the most during these two parts of the cycle (give or take a couple of days). The effects of can be severe as it has been rated as one of the top 5 debilitating conditions in women. It stands to reason then that hormonal changes around these times of a cycle can be blamed. Well… it turns out it can be a little more complex than that. Stunning new evidence shows that the hormones may have a smaller role than you may think in migraines – and the main driver could be coming from an area you least suspected.

There are a few reasons as to why hormones may be over blamed for migraines:

One of the key things to keep in mind is that the research clearly shows that the hormone profile for women with a migraine is no different for the hormone profile for women without a migraine. So, what does this mean? It means if hormones were to blame, then every woman should feel a migraine during the appropriate time in the hormonal cycle. But as that is not the case, and there is no significant difference in hormone levels in the context of migraine – the driver must be away from migraines.

Another idea to think about is that it very possible for someone to have a menstrual migraine both at the start and mid portion of the cycle. This means that migraines can occur BOTH with a drop of estrogen and a surge of estrogen. An intriguing question then develops as to why this is the case! Could it be that the hormones as held as a scapegoat for something else?

So, what happens in the brain?

Estrogen has been shown to be linked to a chemical serotonin, which when released can affect your mood. The higher the serotonin means a better mood whereas a lower serotonin shows a lower mood. The other thing to note is that when serotonin is released – it can affect blood pressure in every woman. This is the key role that hormones play in a specific type of person.


Recent research has shown that the area of the brain where migraines start – the brainstem – is sensitized in those who suffer migraines. Why is this important? This is the area of the brain which is a ‘nerve centre’. It contains all the nerves which supplies the forehead, back of head, neck and face, which are then sent to the brain for processing. Essentially this means that when a brainstem is sensitized, nerve information that goes through this area may be exaggerated and can lead to migraines.


 So lets break it all down…

During a certain time of the period, there is a change of estrogen levels and a change of serotonin levels. This change in serotonin can impact blood pressure through the widening or narrowing of the arteries. This change in pressure gets picked up through the nerves which go to the brainstem. In a sensitized brainstem, this normal information gets misinterpreted as abnormal, which can cause symptoms. Often these symptoms can be intense for what is often a small change of information travelling through the brainstem.

Now that we know that hormonal changes during stages of a period are both normal and consistent in all women, the question is – what can cause a brainstem to become sensitized? If we can address the true drivers of brainstem sensitization, the severe effects of migraine will be reduced.

Here are some key drivers of brain stem sensitization:

  • The neck
  • Stress, anxiety and mental health considerations
  • Diet
  • Lack of exercise
  • Lack of Sleep
  • Family History of migraines (Genetics)


A very common area which can lead be a main driver of migraines is the upper neck. Research has indicated that the ligaments, joints and muscles of the upper neck can all sensitize the brain stem! A previous history of neck injuries or a ‘hunched posture’ may put extra stress on the joints of the neck, which directly influences the brainstem. Once the neck has been identified as a driver of menstrual migraines – manual therapy to the neck is crucial to relaxing the neck and densitizing the brainstem. Massage, heat and specific neck exercises are also important to settle things down.

If you have menstrual migraine and have not had your neck assessed, give us a call at Sydney Headache and Migraine Centre where we can assess and, if required, establish an ideal treatment plan for you.


Book A Migraine/Headache Assessment

Book online or give us a call on 1300MyHeadache (1300 694 323) to organise an assessment with Sydney Headache & Migraine Centre and learn more about what causes your migraines and how we can help treat them.

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