Hormonal Migraine
Up to 60% of women with migraine experience hormone-related attacks. We target the oestrogen withdrawal trigger — not just the symptoms — for lasting prevention.
Book ConsultationThe Oestrogen Connection
Understanding Hormonal Migraine
Hormonal migraine is triggered by the rapid withdrawal of oestrogen, not by low levels themselves. This typically occurs in the 2 days before menstruation when oestrogen drops sharply from its mid-luteal peak, and during the erratic hormonal fluctuations of perimenopause.
The falling oestrogen activates CGRP release in the trigeminal nucleus, sensitises serotonin receptors, and triggers neurogenic inflammation — the cascade that produces migraine pain, nausea, and sensory sensitivity. This is why menstrual migraines are often longer, more severe, and more resistant to triptans than non-hormonal migraine.
Our approach focuses on stabilising the hormonal fluctuation itself through perimenstrual oestrogen supplementation, progesterone optimisation, and evidence-based adjuncts like melatonin and magnesium — reducing migraine frequency at its hormonal source.
Recognising Hormonal Migraine
Common Patterns
The ICHD-3 classifies menstrual migraine as attacks occurring within days -2 to +3 of menstruation.
Migraine Symptoms
- Migraine attacks around menstruation (days -2 to +3)
- Worsening migraine frequency in perimenopause
- Prolonged attacks (24-72 hours)
- Nausea and vomiting with attacks
- Severe photophobia and phonophobia
- Resistance to standard triptan therapy
Hormonal Patterns
- Migraine triggered by pill-free interval (OCP)
- Premenstrual mood dip and fatigue
- Irregular cycles with unpredictable attacks
- Migraine with aura (requires specific management)
Impact on Life
- Lost work and social days
- Medication overuse headache
- Sleep disruption from attacks
- Anxiety about next attack
Evidence-Based Prevention
Treatment Options
Hormonal migraine prevention targeting the oestrogen withdrawal trigger.
Perimenstrual Oestrogen Supplementation
Transdermal estradiol patch (100mcg) applied days -2 to +5 of menstruation to prevent the oestrogen withdrawal that triggers migraine. First-line hormonal prevention (MacGregor, 2014).
Progesterone Optimisation
Micronised progesterone for luteal phase support. Conversion to allopregnanolone provides GABA-mediated analgesic and anti-nociceptive effects in the trigeminal nucleus.
Melatonin Prophylaxis
3mg nightly melatonin shown non-inferior to amitriptyline 25mg for migraine prevention (Gonçalves et al., 2016) without sedative side effects.
Targeted Nutraceuticals
Magnesium glycinate 400-600mg, riboflavin 400mg, and CoQ10 300mg daily — all with Level 2 evidence for migraine prophylaxis.
Hormone-Related Conditions Service
Learn more about our comprehensive approach to hormone-driven conditions.
Suffering from Hormonal Migraine?
Book a consultation to explore hormonal prevention strategies with one of our experienced doctors.