Hormonal migraine vs classic migraine: What’s the difference?
If you get migraines, you may have noticed that they tend to follow a particular pattern. For some women, the migraine appears in the days before their period, often without any warning symptoms. This is commonly associated with the drop in oestrogen that occurs before menstruation.
For others, a migraine begins with flashing lights, zig-zag patterns, changes in vision or tingling before the headache develops. This is known as migraine with aura and is usually not driven by hormonal fluctuations. While there can be exceptions, the two patterns are generally quite different.
Hormonal migraine
Hormonal migraine usually occurs without aura.
It is commonly linked to the hormonal changes that occur before menstruation, particularly the rapid fall in oestrogen during the late luteal phase.
You might feel completely normal throughout most of your cycle, then develop a migraine in the few days before your period.
The timing can be remarkably consistent from month to month.
Hormonal migraine may also occur alongside PMS symptoms such as:
Bloating
Breast tenderness
Food cravings
Fatigue
Mood changes
Irritability
Poor sleep
If your migraine regularly appears in this part of your cycle, the hormonal change may be an important trigger.
Migraine with aura
Migraine with aura is usually not hormonal.
Aura refers to temporary neurological symptoms that occur before or during the migraine. These can include visual disturbances, flashing lights, zig-zag patterns, blind spots, tingling, numbness or difficulty speaking.
The migraine itself may have other triggers, such as changes in sleep, stress, dehydration, skipped meals or other individual factors. Hormonal fluctuations can occasionally contribute to migraine with aura, but this is less typical. Most hormonal migraines do not involve aura, and aura occurring specifically as part of a hormonal migraine is relatively uncommon.
So what's the difference?
A simple way to think about it is:
Hormonal migraine: usually occurs around menstruation, is linked to changing oestrogen levels and typically occurs without aura.
Migraine with aura: usually isn't driven by hormones and involves temporary neurological symptoms before or during the migraine.
There can be overlap, but it is not the usual presentation.
How can a naturopath help with hormonal migraine?
The first step is usually working out whether there is actually a pattern.
A migraine diary can be useful. Record when your period starts, when the migraine occurs and what symptoms you experience. You can also note your sleep, meals, hydration, caffeine, stress and other factors that seem relevant.
After a few months, you may notice that your migraines consistently occur at a particular stage of your cycle.
For example, you may discover that they occur two days before your period rather than randomly throughout the month.
That changes the way we approach the problem.
Looking at the menstrual cycle
If your migraines consistently occur before menstruation, I may focus on the days leading up to your period.
This might involve looking at your diet, sleep, stress, nutrient intake and other symptoms that occur during this part of your cycle.
The aim isn't to "balance your hormones". Your hormones naturally rise and fall throughout the month.
Instead, we want to understand how you respond to those changes and whether other factors are making you more susceptible to migraine.
Looking at nutrients
There is research investigating nutrients including magnesium, riboflavin and CoQ10 and zinc for migraine prevention and management.
Whether supplementation is appropriate depends on the individual.
I may also consider whether other nutritional issues could be contributing to your symptoms. For example, someone with heavy menstrual bleeding and fatigue may need to have their iron status investigated.
Rather than taking several supplements because they are marketed for migraine, it makes more sense to work out what you actually need.
How can a naturopath help with migraine with aura?
If your migraines aren't obviously connected to your menstrual cycle, there are still several areas worth investigating.
Sleep
Changes in sleep can be a migraine trigger for some people.
This includes getting too little sleep, sleeping at inconsistent times or having poor quality sleep.
I may look at your sleep habits and help identify factors that may be contributing.
Food and meal timing
Going long periods without eating can trigger migraine for some people.
It may be worth looking at how regularly you eat, whether your meals contain enough protein and carbohydrates, and whether you tend to go long periods without food.
Hydration
Not drinking enough fluid can also contribute to headaches and migraines.
This can become particularly relevant during exercise, hot weather or when you are losing more fluid than usual.
Caffeine
Caffeine affects people with migraine differently.
Some people find it helpful, while others notice that larger amounts or suddenly reducing their intake brings on a migraine.
Your individual response is more useful than simply following a blanket rule about whether caffeine is "good" or "bad".
Stress
Stress can affect migraine, but this does not mean that migraine is psychological or "all in your head".
The nervous system is involved in migraine, and periods of prolonged stress can make some people more susceptible to their usual triggers.
This is an area where looking at your workload, recovery, sleep and daily routine may be useful.