Nº 03.3Hormone-related conditions
Up to 60% of women with migraine experience hormone-related attacks. We address the oestrogen withdrawal trigger — not just the symptoms — so prevention is possible, not just palliation.
Presentation6 signs
A constellation, not a disease.
HHHC · clinical index
The pathway
Stage · 01
Consult
60-minute in-person assessment with your doctor.
Stage · 02
Test
Full hormone panel, thyroid, metabolic markers.
Stage · 03
Protocol
Bioidentical prescription tuned to your results.
Stage · 04
Follow up
Monitored adjustments as your body responds.
The Oestrogen Connection
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
The ICHD-3 classifies menstrual migraine as attacks occurring within days -2 to +3 of menstruation.
Evidence-Based Prevention
Hormonal migraine prevention targeting the oestrogen withdrawal trigger.
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).
Micronised progesterone for luteal phase support. Conversion to allopregnanolone provides GABA-mediated analgesic and anti-nociceptive effects in the trigeminal nucleus.
3mg nightly melatonin shown non-inferior to amitriptyline 25mg for migraine prevention (Gonçalves et al., 2016) without sedative side effects.
Magnesium glycinate 400-600mg, riboflavin 400mg, and CoQ10 300mg daily — all with Level 2 evidence for migraine prophylaxis.
Learn more about our comprehensive approach to hormone-driven conditions.
Next step
Book a consultation to explore hormonal prevention strategies with one of our experienced doctors.
