Headache and migraine

4 March 2017.

Note: It is possible to experience migraines without headache- please see our pages on nausea, and sensitivity to light/smells etc. for further information.

Headaches are classified into different types;

  • Medication and painkiller headaches– Some headaches are a side effect of taking a particular medication. Frequent headaches can also be caused by taking too many painkillers.
  • Cluster headaches– a rare type of headache that occurs in clusters for a month or two at a time around the same time of year. They’re very painful, causing intense pain around one eye, and often occur with other symptoms, such as a watering or red eye and a blocked or runny nose.
  • Tension headaches– the most common type of headache and are what we think of as normal, “everyday” headaches. They feel like a constant ache that affects both sides of the head, as though a tight band is stretched around it.
  • Hormone headaches– triggered by the menstrual cycle, hormonal medications, the menopause, and pregnancy.
  • Migraines– a severe, throbbing pain at the front or side of the head. Some people also have other symptoms, such as nausea, vomiting and increased sensitivity to light or sound (sometimes without headache- see note above).

Headaches can also have a number of other causes, including [1]:

We focus on hormone headaches and migraines in our tips and tricks section below, because they disproportionately affect people with menstrual cycles [1].

Main symptoms: Hormone headache= headache! Migraine= abdominal pain, diarrhoea, difficulty concentrating, dizziness,  poor temperature control,  migraine headache, nausea, vomiting, restlessnesssensitivity to light/ noise, or visual or other sensory disturbances e.g. smelling things that are not there.


Note: If your symptoms are caused by your hormonal medication, we suggest that you discuss your options with a doctor. These steps may reduce symptom severity, but are unlikely to be able to stop them completely whilst you remain on the same medication.

Managing hormone headaches and migraines:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a few of the key steps that are especially relevant for those suffering from hormone headaches, below;

Try nutritional supplements– magnesium, riboflavin (Vitamin B2), and Coenzyme Q10 (CoQ10), as well as the herbal supplement feverfew, have each had at least one placebo-controlled trial that has shown they can prevent or reduce the severity of hormone headaches or migraines [2] [3].

Magnesium– Studies have shown that people have low brain magnesium during migraine attacks [4] and magnesium deficiency may play a particularly important role in menstrual migraine [5]. Two controlled trials have shown that magnesium supplementation is effective in headache prevention[6] [7]. It is thought that a relatively high dose of Magnesium (400- 600 mg daily) is best to prevent migraines- but if you begin to develop diarrhoea, reduce the amount you are taking [2].

Vitamin B2– riboflavin- (200-400 mg daily) can reduce the frequency of migraines and hormone headaches [8]. In the only study involving riboflavin alone, 59% of the participants who took 400 mg/day riboflavin for 3 months experienced at least 50% reduction in migraine attacks compared with 15% for placebo[8].

Co-enzyme Q10– In one study, 61.3% of the patients treated with Co-enzyme Q10 had a greater than 50% reduction in number of days with migraine headache. The reduction in migraine frequency after 1 month of treatment was 13% and this improved to 55% by the end of 3 months of therapy [9]. The data presented in this trial suggest that CoQ10 starts to work within 4 weeks but usually takes 5 to 12 weeks to yield a significant reduction in days with migraine [9]. In another study migraine attack frequency after 4 months of treatment was reduced at least 50% in 48% of patients as compared to 14% for placebo [10].

Feverfew– Seventeen migraine patients who already used feverfew daily as migraine prophylaxis enrolled in a controlled trial in which 8 patients continued to receive feverfew while 9 stopped taking it and received placebo treatment instead [11]. Those who received placebo had a significant increase in the frequency and severity of headache (an average of 3.13 headaches every 6 months when taking placebo vs. only 1.69 headaches every 6 months when taking feverfew), nausea, and vomiting, whereas there was no change in the group receiving feverfew [11]. In a larger study of 72 patients, feverfew was associated with a 24% reduction in the mean number and severity of attacks although the duration of the individual attacks was unaltered [12].

Avoid alcohol– alcohol is a potential trigger for migraines so if this is the case for you (track your symptoms/ diet to find out) it may be best to reduce your consumption, or avoid it completely [13], and as many of us know from experience (!) too much alcohol can lead to a headache the following day (known as a hangover) [13].

Eat regular meals– Fasting or skipping meals are well-known migraine triggers, try to eat little and often [14].

Chocolate and migraine- A popular myth suggests that chocolate can trigger migraine. The evidence does not support this. The myth may have arisen because of cravings which can form part of the premonitory phase of migraine, so when the chocolate is eaten during this phase the migraine has actually already begun… [15]. However, this does not mean that it’s a good idea to eat a lot of chocolate- sharp fluctuations in blood sugar levels are known to worsen most hormone-related symptoms [14].

TOP TIPS! Headaches can also be caused by dehydration… Make sure you drink at least 6 glasses of water per day.


Although some peoples’ experience is that exercise triggers a migraine attack, research suggests that moderate regular exercise can be an effective way to reduce the frequency of attacks [16].

If you have found that exercise has triggered a migraine, it could be due to the following reasons [16]:

  • You start exercising suddenly with no prior planning which means that your body has a sudden demand for oxygen.
  • You have not eaten properly before exercising so that your blood sugar level falls as you become very hungry.
  • You have not taken sufficient fluids before and during exercising so your body becomes dehydrated.
  • You start a strenuous ‘keep fit‘ programme at the same time as ‘healthy’ new diet . If not managed properly, these changes to your lifestyle can act as an additional trigger.
  • You undertake strenuous infrequent exercise which causes stiff, aching muscles which can then act as a trigger.
  • You experience a minor blow to your head during sport, for example you may be hit by or head a football. This can trigger an instantaneous migraine aura.
  • A headache can be brought on by and occur only during or after strenuous exercise.  This is called exercise headache (previously referred to as exertional headache) and may last from 5 minutes to 48 hours after the exercise. It tends to occur in hot weather or at high altitude.

Previous studies have suggested that mild regular aerobic exercise offers the most benefits to those with migraine [16]. Remember, it is important to choose an exercise activity that you enjoy. It could be jogging; swimming, dancing, cycling, or brisk walking…

TOP TIP! It is worth tracking both your migraine attacks and any exercise you have undertaken. This will give you an idea of the affect aerobic exercise has had on your migraine and any steps to take to help ensure that exercise is not a trigger for you. It will also act as a record of whether you are decreasing or increasing migraine medication.


Reduce stress hormone levels– Hormone headaches/ migraine and stress are strongly linked. Indeed, anxiety, excitement and any form of tension or shock can all lead to a headache or migraine [17].

This suggests that it may be (rapidly) changing levels of stress hormones that act as a trigger for migraines. This certainly makes sense in relation to menstrual migraines, and hormone headaches, since these are (by definition) triggered by rapidly changing levels of sex hormones, known to directly interact with the HPA (Hypothalamic Pituitary Adrenal) stress axis [18]. So, as always with hormone-related symptoms, it is important for migraneurs to reduce anxiety and stress, perhaps through improved self-esteem, or by incorporating relaxation techniques into daily activities. In fact, therapeutic massage (body or head) has been found to be as effective as  migraine medication in some trials [19].

Top tip! Both too much or too little sleep can trigger a migraine [17]. So, try to keep to a sleep routine, going to bed and getting up at roughly the same time each day can make a huge difference…


If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing hormonal headaches or migraines- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

  1. NHS. (2015) Headaches. [ONLINE] Available at: http://www.nhs.uk/conditions/Headache/Pages/Introduction.aspx. [Accessed 20 April 2017].
  2. Migraine Trust. (2015) Supplements and herbs. [ONLINE] Available at: https://www.migrainetrust.org/living-with-migraine/treatments/supplements-and-herbs/. [Accessed 20 April 2017].
  3. Daniel O, Mauskop A. (2016) ‘Nutraceuticals in Acute and Prophylactic Treatment of Migraine’ Curr Treat Options Neurol Apr;18(4):14. doi: 10.1007/s11940-016-0398-1. PubMed PMID: 26923604
  4. Ramadan NM, Halvorson H, Vande-Linde A. (1989) ‘Low brain magnesium in migraine’ Headache 29:590–593.
  5. Mauskop A, Altura BT, Altura BM. (2001) ‘Serum ionized magnesium in serum ionized calcium/ionized magnesium ratios in women with menstrual migraine’ Headache 42:242–248
  6. Facchinetti F, Sances G, Borella P, et al. (1991) ‘Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium’ Headache 31:298–301.
  7. Peikert A, Wilimzig C, Kohne-Volland R. (1996) ‘Prophylaxis of migraine with oral magnesium: results from a prospective, multicenter, placebo-controlled and double-blind randomized study’ Cephalalgia 16:257–263.
  8. Schoenen J, Jacquy J, Lenaerts M. (1998) ‘Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial’ Neurology 50:466-470
  9. TD Rozen, ML Oshinsky, CA Gebeline, KC Bradley, WB Young, AL Shechter & SD Silberstein.  (2002) ‘Open label trial of coenzyme Q10 as a migraine preventive’. Cephalalgia 22, 137–141.
  10. Sandor S, Di Clemente L, Coppola G, et al. (2005) ‘Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial’ Neurology 64:713.
  11. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. (1985) ‘Efficacy of feverfew as prophylactic treatment of migraine’. BMJ 291:569-573
  12. Murphy JJ, Heptinstall S, Mitchell JRA. (1988) ‘Randomized, double-blind, placebo-controlled trial of feverfew in migraine prevention’. Lancet. 2:189-192.
  13. Dueland AN. (2015) ‘Headache and Alcohol’ Headache Jul-Aug;55(7):1045-9. doi: 10.1111/head.12621. Epub 2015 Jun 29. Review. PubMed PMID: 26121267.
  14. Finocchi C, Sivori G. (2012) ‘Food as trigger and aggravating factor of migraine’ Neurol Sci May;33 Suppl 1:S77-80. doi: 10.1007/s10072-012-1046-5. Review. PubMed PMID: 22644176
  15. Lippi G, Mattiuzzi C, Cervellin G. (2014) ‘Chocolate and migraine: the history of an ambiguous association’. Acta Biomed Dec 17;85(3):216-21. Review. PubMed PMID: 25567457
  16. Lockett DM and Campbell J F. (1992) ‘The effects of aerobic exercise on migraine’ Headache 32(1): 50-4
  17. National Clinical Guideline Centre (UK). (2012) ‘Headaches: Diagnosis and Management of Headaches in Young People and Adults’ [Internet]. London: Royal College of Physicians (UK); Sep. Available from http://www.ncbi.nlm.nih.gov/books/NBK299072/
    PubMed PMID: 26065049
  18. Facchinetti F, Fioroni L, Martignoni E, Sances G, Costa A, Genazzani AR. (1994) ‘Changes of opioid modulation of the hypothalamo-pituitary-adrenal axis in patients with severe premenstrual syndrome’. Psychosom Med. Sep-Oct;56(5):418-22. PubMed PMID: 7809341.
  19. Chaibi A, Tuchin PJ, Russell MB. (2011) ‘Manual therapies for migraine: a systematic review’. J Headache Pain Apr;12(2):127-33. doi: 10.1007/s10194-011-0296-6. Epub 2011 Feb 5. Review. PubMed PMID: 21298314; PubMed Central PMCID: PMC3072494.

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