Headaches: What causes them and how to treat them

Headaches getting you down? Learn to identify the triggers – and the best treatment – for your headaches.

Hormonal headaches
Hormonal headache
Hormonal headaches are typically migraine headaches, occurring on one side of the head and influenced by the menstrual cycle.

What it feels like
Throbbing pain affecting one side of the head and often more severe before or during a menstrual period. Other symptoms may include nausea, vomiting and sensitivity to light and sound. An aura may precede a menstrual migraine but it is not typical. May be accompanied by other premenstrual symptoms such as cramps and muscle or joint aches.

About 60 to 70 per cent of women with migraines get headaches during the time around menstruation. Most suffer menstrual-related migraines, which means they also get headaches at other times in their cycle in association with other triggers. Less common is "true menstrual migraine," says Giammarco, "which occurs only during the menstrual cycle and doesn't occur in relation to triggers other than hormones."

Frequency and duration
Menstrual-related migraine attacks typically occur between two days before and three days after menstruation begins and, in theory, are triggered by drops in estrogen levels. Hormonal headaches may also occur around ovulation, when estrogen levels surge and then drop. Migraines improve for many women during menopause, though they may worsen during perimenopause when large hormone fluctuations can occur. Headaches last from four to 72 hours, but tend to persist longer and be more severe than nonmenstrual migraines.

Changes in estrogen levels before and during menstruation, around ovulation, during pregnancy and in perimenopause. Falling estrogen levels usually correspond to drops in serotonin, a brain chemical known to reduce pain sensitivity. Birth control pills worsen migraine headaches for some women and reduce them for others.

Sufferers of hormonal headaches can ask their doctor for specific recommendations about taking triptans or anti-inflammatories, which can be used as "mini-prevention" drugs taken around the time of the menstrual period.

Since women are more sensitive to triggers before and during menstruation, regular sleep, exercise, healthy eating, relaxation therapies and avoidance of known triggers at that time can help to prevent hormonal headaches, suggests Giammarco. If hormone headaches occur frequently, long-term preventive medications, such as beta blockers, calcium channel blockers, tricyclic antidepressants and anticonvulsants, can be effective in reducing their frequency and severity. Each class of drugs has its own benefits and side-effects.
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