You probably already know that three times more women than men suffer from migraine. And if you are one of those many women, you have also probably asked why. The typical and obvious answer is that it’s our hormonal differences that make us more susceptible to migraine than men. But since not all women get migraines, we need to take a closer look at some of the factors that lead some women’s hormones to get out of balance in such a way that this imbalance manifests as migraine – especially “hormonal” migraine or menstrual migraine.
Since I am not an endocrinologist, the inquiry for this blog post will be fairly general and necessarily simplified (for example, there are many types of estrogen but I will just refer to “estrogen” as though it is one thing). I think that this simplicity will still be accurate for the purposes of providing a general understanding for why reducing histamine and glutamate (as per the SimplyWell Protocol) can work to alleviate “hormonal” migraines – and how fluctuating hormone levels at ovulation raise histamine, while low estrogen and progesterone levels (exacerbated by mineral deficiencies) raise glutamate levels and contribute to menstrual migraine.
There are surely additional factors that go into why women get more migraine at ovulation and menstruation, and there are other inflammatory molecules besides histamine and glutamate that play a role in migraine pathology, but these two are certainly big players in menstrual migraine.
The Fluctuation of Estrogen and Progesterone at Ovulation and Menstruation
One very basic explanation for why migraine occurs during ovulation and menstruation has to do with the sudden spikes and drops of hormones during these times. Women who have reached menopause do not have such intense hormonal fluctuations.
Notice in the graph below of a “normal” menstrual cycle that estrogen is high at ovulation while progesterone only starts to rise a little at this point. Progesterone peaks in the week after ovulation (and estrogen is at its lowest point), then starts to plummet again leading up to menstruation. Both estrogen and progesterone get very low right before and during menstruation.
It is most common for women to get migraine directly prior to and during menstraution – more common than women getting migraine during ovulation. This is because both levels of estrogen and progesterone are low at this time.
But why would low levels of estrogen and progesterone lead to migraine?
Histamine, Glutamate, and Menstrual Migraine
Both histamine and glutamate are excitatory neurotransmitters implicated in migraine, and levels of these two amino acids in the gut and brain are affected directly by hormones as they shift at different times of the menstrual cycle.
- Estrogen and progesterone are glutamate transporters, ie, they help to reduce glutamate buildup. Excitotoxicity from glutamate is one key feature of migraine. Therefore, low levels of estrogen or progesterone (at menstruation) contribute to excitotoxicity. (Source)
- Histamine intolerance or overload is a feature of migraine. Estrogen levels trigger mast cells to release histamine, so estrogens (including xenoestrogens and environmental pollutants that mimic estrogen), especially the estrogen spike at ovulation, will contribute to histamine overload. (Source)
- But because most menstrual migraines occur at menstruation when both estrogen and progesterone are low, I hypothesize that glutamates are playing an even larger role in migraine than histamine.
- Estrogen also down-regulates DAO (diamine oxidase), one enzyme that breaks down histamine. Estrogen replacement therapy and “the pill” increase estrogen levels and deplete progesterone – which may be one reason why headache is a known side-effect of the pill. (Source)
- Progesterone is used by the body to make cortisol. Therefore excessive amounts of stress will deplete progesterone levels, and thereby raise glutamate. Progesterone is also needed to upregulate DAO (diamine oxidase), one enzyme that breaks down histamine. (Source)
- Hormones are processed by the liver, so anyone with an overwhelmed liver will necessarily have more of a tendency towards hormonal imbalances. (Source)
- Stress depletes zinc, which is needed to make progesterone. (Source). Zinc and copper have a reciprocal relationship. When zinc is depleted, copper levels rise, leading to more estrogen and histamine.
- When both zinc and copper are low, hormonal function of both estrogen and progesterone is compromised.
- Sudden drops in estrogen or progesterone during ovulation or directly prior to menstruation may account for migraines coming on at these times. (Source)
Additional Factors Influencing Menstrual Migraine
Digestive health clearly plays a role in both instances of hormonal migraine during ovulation and prior to menses. When the gut flora are out of balance, there is a proliferation of bacteria that produce glutamate and histamine – meaning that the histamine and glutamate load from food sources is ADDING TO the load already present in the (imbalanced) gut.
So for many women who have a large load of glutamate and histamine from both food and gut bacteria sources, any situation in which estrogen, progesterone, or both get very low can lead to an overload – and a migraine (for reasons described in the last section).
If a woman’s stress load is very high or her sleep quality is poor, she will be even more susceptible to menstrual migraine. But why? Because both stress and poor sleep quality lead to mineral depletion (especially of magnesium and zinc). Minerals are key building blocks for all enzymes, including those that manufacture estrogen and progesterone.
We know that stress reduction is key to healing migraine because cortisol, the hormone released during stress, is made from progesterone; so, stress leads to insufficient supplies of progesterone to clean up glutamates.
Drinking coffee or caffeine also increases cortisol so is antithetical to healing hormonal migraine (or any kind of migraine). Coffee should not be consumed regularly, and only used as a last resort to help abort a migraine.
Since most migraineurs usually have insomnia or poor sleep quality once they are asleep, coffee as well as foods and medications like aspirin which contain caffeine should also be reduced or avoided. It can be very difficult to heal insomnia when consuming large amounts of caffeine. Since the body repairs itself at night, getting quality sleep is crucial to healing menstrual migraine.
Migraine and Pregnancy
Luckily for most women who suffer from migraines, when they get pregnant, these migraines miraculously disappear – usually in the third trimester. What could explain this?
To keep inflammation at bay, the placenta increases DAO (diamine oxidase) production, effectively reducing histamine. By the third trimester, these levels are peaking.
Estrogen and progesterone both rise in the third trimester. While estrogen generally increases histamine, this is presumably counter-balanced by the high DAO from the placenta. And again, since estrogen and progesterone are both glutamate transporters, these higher levels of hormones help reduce migraine during pregnancy as well.
Unfortunately, following pregnancy, these same hormones plummet again. The migraine-prone mother is likely to be revisited by her migraines, but this time they may be much worse due to the demands of motherhood, sleep deprivation, or recovering from the all-too-common c-section operation and a disrupted microbiome from the antibiotics and other meds.
Hormonal Migraines and Menopause
The vast majority (probably 90%) of my clients are peri- or post-menopausal. While it’s commonly known that many women’s migraines disappear after menopause, I think this is changing. At least some women’s migraines are getting worse with menopause.
This means that migraine is not just a result of the sudden shifts and fluctuations of estrogen and progesterone in the cycle (in the case of menstruating women), but also from chronically low levels of progesterone and estrogen during menopause.
Why, then, do some women’s migraines go away when they reach menopause while other women’s do not? I believe the women who continue to have migraine have a much higher incidence of gut flora imbalances, digestive problems, mineral imbalances, and liver disease than those whose migraines go away.
And it’s no wonder. While it’s normal for digestive health to decline somewhat with age, we have to consider why many women who have hit menopause are so overwhelmed with health problems.
Peri and post-menopausal women with chronic migraine will tend to have a large constellation of other symptoms besides migraine, such as fibromyalgia, uterine fibroids, cystic fibrosis, cataracts, depression, etc. They tend to be on more medications, more synthetic hormones, and have had more surgeries (read: more antibiotics and a disrupted microbiome) – including plastic surgery.
Women with a congested liver will process estrogen less efficiently – and thyroid hormones too! Liver congestion then spills over into gallbladder problems, which are also chronic in migraineurs. And the cascade of downstream problems continues . . . . They are all connected, but doctors are treating them as though they are separate conditions.
Many of the women who come to me also have common character traits: highly empathic women who are givers, they tend to overextend themselves and not know how to slow down. These women, even while they are on anti-depressants, very often have an obvious lust for life. They are not fundamentally depressed people, they are simply in a very depressing situation battling chronic migraine for literally decades.
All of these meds, and all of this stress, leads to more and more mineral depletion. Which leads to lower hormone levels, and higher glutamate and histamine levels. Yes, I’m repeating myself.
Let me say it again, and simply: the solution is to stop doing the things that deplete minerals (stress, meds), slow down – and replenish your minerals.
Healing Menstrual Migraine with the SimplyWell Protocol
From the people I’ve coached who were not menopausal and had hormonal migraine I can confirm that the SimplyWell Protocol can address so-called “hormonal migraine”, but its success (and how fast that success happens) depends on a number of factors.
One factor is how long the migraines have existed (ie, how chronic the pattern is) – with less chronic, shorter history of menstrual migraines resolving within 2-3 months.
The second major factor is how many medications the person is on to manage migraines, which always seems to slow healing and success on the Protocol down (probably because of the way that the medications congest the liver, alter the microbiome, and deplete minerals).
So: people who have already been eating a whole foods diet, have had migraines for 5-10 years instead of 20 or 30 years, and have used minimal medications (meaning fewer than five doses of any pharmaceutical per month) will recover quicker on the Protocol than those whose pattern of depletion has been ongoing for decades and involves a big dependence on medications.
However inconvenient it may be, the fact remains that healing takes time.
With longstanding chronic migraine, the level of mineral and nutrient depletion on a cellular and tissue level can be profound. While the gut flora get rehabilitated on the Protocol, and nutrient absorption improves, the body will begin to “catch up” on long-neglected repairs. The body follows the most intelligent sequence in healing, but improvement of hormonal functioning is not always the first in the sequence when the body is deciding where best to utilize nutrients.
As an example to the last point, the B vitamins and also especially copper are crucial for hormonal balance and yet they are also required for thousands of other processes in the body.
The good news is that even while healing takes time, the body does know the right sequence, and improvements are usually seen long before the symptoms are completely eliminated.
Usually clients on the Protocol who present with hormonal migraine see an initial clearing of the migraines and headaches they have during the rest of the month, an improvement in energy, and symptoms of migraine during their moon cycle gradually becoming less severe.
Hair Tissue Mineral Analysis to Heal Migraine
Deeper-seated, longer-standing hormonal imbalances that have been ongoing for decades may need additional support in the form of specific mineral balancing of copper, zinc, and other minerals to improve electrolyte, enzyme, and hormone function.
Mineral levels can be very closely and accurately analyzed using a Hair Tissue Mineral Analysis (HTMA). Marya is trained in HTMA and can assist with personalized mineral rebalancing as part of a one-on-one coaching session.
In general, many women with migraine and hormonal imbalance have copper dysregulation (either low copper, or latent elevated copper). Copper is needed to support metabolic function and the synthesis of the DAO enzyme, as well as thousands of other important enzymes (such as the enzyme MAO, which breaks down tyramine). Therefore supplementing with zinc without sufficient copper can be very problematic since it could further deplete copper levels if done improperly. This is why one-on-one guidance is often necessary to balance zinc and copper levels, based on actual specific data from an individuals HTMA lab report.
To Sum Up . . .
Healing menstrual migraine involves reducing estrogen load, increasing progesterone, reducing glutamate and histamine load, cleansing the liver, improving digestive function so that minerals are properly absorbed, balancing minerals (especially zinc and copper), and reducing medications and stress.