What you need to know about migraines in women
Are migraines in women caused by hormones?
Hormones may TRIGGER migraines … but that does NOT always mean they are the CAUSE of migraines in the first place.
Both women and men experience migraines. However, migraines tend to be 3x more common in women. Researchers believe that estrogen is one of the key factors. However, what you need to know about migraines in women is that estrogen and hormones may not be the only factor involved.
Let me ask you a strange question: does wind cause a forest fire?
By itself, the answer is no. A spark of heat causes a fire. However, if you add drought and then a strong wind, the combination of these conditions can be what causes a tiny fire to become a terrible inferno.
The same thing may be true of migraines and hormones. Hormones are like the wind. They can certainly make an existing situation worse. However, there must still be an existing fire - a pre-existing situation unrelated to the hormones themselves - where the combination of the two can produce a wildfire, aka migraine.
I’d like to introduce you to the possibility that the underlying cause of migraines in women may not always be hormones, but may actually be a mechanical misalignment in the upper part of the neck, called the atlas or C1 vertebra, that creates physical tension on the brainstem and that is simply aggravated with hormone fluctuations.
Estrogen and Migraines in Women
Researchers believe that plays a major role in why women tend to experience migraines more commonly than men: especially pre-menstrual and menopausal migraines.
As a very brief overview of a woman’s normal monthly cycle, there is a reciprocal relationship between two hormones: estrogen and progesterone. As estrogen rises, progesterone falls; as progesterone rises, estrogen rises.
Before a menstrual cycle is when estrogen is at its lowest level. Estrogen has what is known as a “vasomotor” effect, which means that it affects your sympathetic nervous system. Your sympathetic nerves are what control blood vessel dilation everywhere in your body.
They are also what regulate your “fight or flight” reflexes, which are associated with anxiety, jitteriness, agitation, etc.
Any chemical substance that has a sedentary effect on the sympathetic nervous system can produce a feeling of “calmness.” Coffee. Chocolate. Endorphins (both natural and artificial). Estrogen has a similar effect.
However, if you develop chemical “dependency” on any of these substances, and then suddenly take them away for even a few days, what happens? Increased anxiety, increased jitteriness, increased agitation. Basically, withdrawal or “detox” symptoms!
The reduction of estrogen as a normal part of a woman’s reproductive cycle behaves similarly, hence the condition known as “premenstrual syndrome.”
And as part of the “withdrawal” may also come headaches or migraines!
Pre-menopause and menopause bring a similar condition where estrogen levels progressively decrease in a woman through her 40s and 50s. Here is where common medical therapy involves hormone replacement to reduce the chemical shock on the system.
Fire (Cause) + Wind (Condition) = Wildfire (Effect)
So are menopause and migraine connected? The answer is yes. However, what you need to know about menstrual migraines is that the connection may not be the way that you always thought!
You see, not all women experience migraines! If estrogen was the sole factor, then all women would experience pre-menstrual and menopausal migraines. But that doesn’t happen!
Moreover, as we already used the analogy, estrogen by itself is a natural element, like the wind. By itself, it does not and cannot cause a fire. However, if there is already some other condition that simultaneously is affecting the sympathetic nervous system - the metaphorical fire - it is their combined activity that may produce the migraines.
Therefore, there must be some other variable that is involved.
So what could that variable be?
Many healthcare experts and migraine specialists agree that one of the most important factors is the integrity and alignment of the vertebrae in your upper neck.
The top two bones in your neck called the C1 (atlas) and C2 (axis) have a unique connection with the base of your skull. They are suspended by muscles and ligaments, which allow for a huge amount of flexibility plus your ability to move your head.
They are also directly tethered to the connective tissues that surround your brain spinal cord via thick ligaments called myodural bridges.
This connective tissue is called the meninges and is comprised of three layers. The middle layer, which is known as the arachnoid membrane is so-called because of its “spiderweb-like” appearance. It is an intricate network of arteries, veins, lymph channels, and nerves that supply your brain.
The reason this later is so significant is that the nerves in this connective tissue are responsible for two primary functions: 1) sympathetic nerve activity (which regulates blood flow and lymph drainage) 2) and sensation, such as pain.
It is believed that irritation to the meninges can cause irritation to the sympathetic and sensory nerves, which your brain perceives as a migraine. Irritation to the nerves is also believed to be linked with other migraine-like conditions including cluster headaches and daily persistent headaches (DPH).
So what’s the link between your C1 and migraines?
It’s those myodural bridges! Image if you were pulling on a piece of string: if you pull on one end, there is tension at the other end. So, if there is a mechanical problem with the normal alignment of your C1 vertebra, it may produce a physical tension that in turn pulls on the connective tissue.
This tension may well be the initial “fire” that sets the stage for menstrual migraines or menopausal migraines when changes in estrogen levels act change like the “wind.”
Has the cause of your migraines been diagnosed?
These conditions involving misalignment of the upper neck affecting your nervous system may be greatly underdiagnosed in the general population.
Foremost, they are caused by head, neck, or whiplash injuries, but not always the kinds that cause bleeding or broken bones. Because your body has an amazing ability to compensate, many of these injuries don’t even cause pain … at least initially.
Think of it like compound interest. A few cents may not be worth very much. However, if you allow the interest to accumulate long enough, you can amass a small fortune in a relatively short period of time.
Moreover, when you consider the sensitivity of the nerves in the upper part of your neck, you can appreciate how even small things can cause big problems. Consider the last time you ever had a pebble in your shoe (1cm). Or a splinter in your finger (1mm). Or a speck of dust in your eye (<<1mm).
It is the reason so many of these problems go undiagnosed! It is because many migraine specialists aren’t even thinking of looking for them! The result is that they attributed your migraines to stress or hormones or diet or other things like that.
However, the reality may well be the true underlying cause of your migraines is a mechanical problem - the fire - and that all the other things are simply the triggers: the wind.
So if it is possible that you have an issue affecting your upper neck, how might you know that it is connected with your migraines? Well, there are a few things to consider.
- You’ve had a brain MRI and neck scan, but there are no obvious signs of pathology like tumors or infections. That’s a good thing. However, if you have straightening of your neck or signs of degenerative arthritis, these are key indicators that there is a mechanical problem with your neck.
- You experience neck pain, shoulder pain, headaches, vertigo, or dizziness in addition to migraines. Commonly, if you experience more than one symptom in your body, there is usually an underlying connection. These are simply some of the more common symptoms.
Ultimately, the ideal way to identify if you have a problem with your neck is to have it properly assessed by a healthcare professional whose sole focus is on the neck, head, and brain health. There is where an upper cervical chiropractor may be able to help you.
An upper cervical chiropractor is an advanced certified chiropractic doctor, who has completed a post-doctoral certification program in the diagnosis and treatment of head-neck conditions, which include migraines. Unlike general chiropractic, there is no spinal manipulation, twisting, or cracking.
The key difference is precision in the use of specific neurological tests, physical tests, and also advanced diagnostic imaging where an upper cervical chiropractor is able to measure the direction and exact degree of any misalignments in your neck.
With this level of information, an upper cervical chiropractor is able to use a natural approach to healing - without relying on drugs, surgery, or spinal manipulation - to correct the alignment and motion in your upper neck. It is like getting a custom-made key for your house. When it is designed specifically for you, it doesn’t take much force at all!
So how an upper cervical chiropractor may be able to help you is by designing an adjustment procedure made specifically for you that may be able to help where no other stretch, procedure, or medication has been able.
As we’ve already said, there may still be plenty of triggers that create your headaches. However, if we are able to correct one major source of underlying stress, it may well go a long way to helping you overcome your migraines where so many other things have not helped.
Who is upper cervical care dedicated?
Often, people ask if “upper cervical, osteoarthritis, and chiropractic care are okay to have together?” In a nutshell, osteoarthritis is often a major indicator that you have needed chiropractic care for a long time.
And while certain procedures including some types of spinal manipulation are not appropriate if you have osteoarthritis, and upper cervical chiropractic - because it does not use manipulation - can still work together. (That is why it is important to have the right tests done first to verify what can, should or should not be done).
Many people also ask, “Is seeing a chiropractor safe during pregnancy?” With an upper cervical chiropractor, the answer is yes.
The once caveat is that if you have not previously seen an upper cervical chiropractor and need x-rays before starting care, that may not be possible on account of the pregnancy and wanting to minimize x-ray exposure. (In a fully grown adult, a few x-rays don’t have a high chance of risk, but there may be an increased fetal risk that we do not wish to take if you are pregnant).
But to receive care, yes, that may actually be a very positive thing.
A different approach for helping women with migraines
I hope that this article has helped give you a better understanding of what you need to know about migraines in women and also what you need to know about menstrual migraines and also menopausal migraines.
Hormones are one part of the puzzle, but may not be the only thing that is needed in getting to the cause and solution to the problem.
So, what can you do about it?
If you have found this article has been valuable, then we would like to invite you to take the next logical step. We would like to hear from you!
Our practice offers a complimentary 15-minute over the phone consultation where you can speak with your principal upper cervical chiropractor, Dr. Jeffrey Hannah, to discuss your condition and to ask any questions you may have so that you can decide if care may be right for you.
Our practice, Atlas Health, is the premier upper cervical health center in Australia. We believe in the innate potential for human beings to have an extraordinary life.
Our focus is in providing hope for people who have not been able to find answers elsewhere - where all their other tests come back as “normal” - in allowing their body to heal the way it is designed to - naturally - and most importantly in helping them find long term solutions so that they can enjoy the quality of life that they desire most.
Our principal is Dr. Jeffrey Hannah, who is an advanced certified Blair upper cervical chiropractor. Dr. Hannah serves on the Blair Chiropractic Society Board, is an instructor, international speaker, published author, and recognized leader in the field of upper cervical specific care.
Our practice is located in North Lakes (north Brisbane) to provide care for the local communities of Narangba, Mango Hill, and Burpengary as well as for people across the greater Brisbane, Sunshine Coast, and SE Queensland area. We also take care of many people who travel across and even interstate.
If you would like to schedule a complimentary 15-minute consultation to speak with Dr. Hannah, you can contact our office at 07 3188 9329 or complete the Contact Us email at the top of this page.
We appreciate your trust in taking care of your health, and we look forward to hearing from you to do the best that we can to help you.
Atlas Health Australia - “Hope, healing, and wellbeing from above-down, inside-out.”
Broner SW, Bobker S, Klebanoff L. Migraine in Women. Semin Neurol. 2017;37(6):601‐610. doi:10.1055/s-0037-1607393. https://pubmed.ncbi.nlm.nih.gov/29270933/
Burgos-Vega C, Moy J, and Dussor G. Meningeal afferent signaling and the pathophysiology of migraine. Prog Mol Biol Transl Sci. 2015;131:537-64. doi: 10.1016/bs.pmbts.2015.01.001. Epub 2015 Feb 9.
Calhoun AH, Ford S, Millen C, et al. The prevalence of neck pain in migraine. Headache. 2010 Sep;50(8): 1273-7. doi: 10.1111/j.1526-4610.2009.01608.x. Epub 2010 Jan 18.
Domínguez Salgado M, Santiago Gómez R, Campos Castelló J, Fernández de Péres Villalaín MJ.. An Esp Pediatr. 2002 Nov;57(5):432-43. https://www.ncbi.nlm.nih.gov/pubmed/12467547
Enix DE, Scali F, Pontell ME. The cervical myodural bridge, a review of literature and clinical implications. J Can Chiropr Assoc. 2014 Jun;58(2):184-92.
Gaul C, Meßlinger K, Holle-Lee D, Neeb L. . . Dtsch Med Wochenschr. 2017 Mar;142(6):402-408. doi: 10.1055/s-0042-111694. Epub 2017 Mar 22. https://www.ncbi.nlm.nih.gov/pubmed/28329901
Ibrahimi K, Couturier EG, MaassenVanDenBrink A. Migraine, and perimenopause. Maturitas. 2014;78(4):277‐280. doi:10.1016/j.maturitas.2014.05.018. https://pubmed.ncbi.nlm.nih.gov/24954701/
Lewis DW. Headaches in children and adolescents. Am Fam Physician. 2002 Feb 15;65(4):625-32. https://www.ncbi.nlm.nih.gov/pubmed/11871680
MacGregor EA. Migraine, menopause, and hormone replacement therapy. Post-Reprod Health. 2018;24(1):11‐18. doi:10.1177/2053369117731172. https://pubmed.ncbi.nlm.nih.gov/28994639/
Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357:j1805. doi: 10.1136/bmj.j1805. https://www.ncbi.nlm.nih.gov/pubmed/28512119
Rothner AD, Linder SL, Wasiewski WW, O'Neill KM. Chronic nonprogressive headaches in children and adolescents. Semin Pediatr Neurol. 2001 Mar;8(1):34-9. https://www.ncbi.nlm.nih.gov/pubmed/11332864
Viana M, Sances G, Terrazzino S, et al. When cervical pain is actually migraine: an observational study in 207 patients. Cephalalgia. First Published December 7, 2016: https://doi.org/10.1177/0333102416683917.
Yan J, Melemedjian OK, Price TJ, Dussor G. Sensitization of dural afferents underlies migraine-related behavior following meningeal application of interleukin-6 (IL-6).
Mol Pain. 2012 Jan 24;8:6. doi: 10.1186/1744-8069-8-6.