Do you experience migraines before your period every month?
Hormonal migraines, also called menstrual migraines, are common in women in their 30s and 40s. Many women are told their hormone levels are “normal,” yet they continue to struggle with debilitating headaches tied to their cycle.
Recently, I worked with a 38-year-old woman experiencing 2–4 migraines per month, typically one to two days before menstruation. Her symptoms included:
Throbbing headache behind one eye
Light sensitivity
Fatigue
Nausea
PMS symptoms
Blood work showed normal estrogen levels. However, because her migraines were clearly cyclical, we evaluated her estrogen metabolism using a comprehensive dried urine hormone test (DUTCH test).
Why Estrogen Metabolism Matters in Hormonal Headaches
Estrogen is broken down in the body through several metabolic pathways. Some pathways produce more protective metabolites, while others create more reactive compounds that may contribute to inflammation.
Her results showed she was metabolizing more estrogen down the 4-hydroxy (4-OH) pathway, which produces more reactive metabolites. Research shows that the natural estrogen drop before menstruation is a well-recognized trigger for menstrual migraines (MacGregor, 2015). When estrogen metabolism is more inflammatory, some women may be more sensitive to these hormonal shifts.
A Natural, Supportive Approach to Menstrual Migraines
Rather than suppressing hormones, our approach focused on supporting healthy estrogen metabolism and reducing inflammatory burden.
Her plan included:
Increasing intake of cruciferous vegetables
Targeted nutritional support to encourage balanced estrogen metabolism
Supporting methylation pathways with appropriate B vitamins
Magnesium support
Antioxidant support
Stress and sleep optimization
Over several cycles, her hormonal migraine frequency and severity decreased significantly, and her PMS symptoms improved.
Struggling with Cyclical Migraines?
If you experience:
· Migraines before your period
· Worsening headaches in your late 30s
· PMS with headaches
· “Normal” labs but ongoing symptoms
A deeper look at hormone balance and estrogen metabolism may provide helpful insight.
If you’d like to explore personalized testing and support for hormonal migraines, we’re here to help.
Reference:
MacGregor, E.A. (2015). Migraine in women. Seminars in Neurology, 35(6), 601–610.
ABOUT THE AUTHOR
Since 2005, Dr. Fey has helped women, men, and children find real solutions to their health concerns. She truly believes that giving the proper care and nutrients your body has an amazing ability to heal. She is committed to finding the root cause of illness by utilizing a whole body approach not just focusing solely on presenting symptoms. With her scientific background, Dr. Fey uses science based natural approaches to treating disease.
Dr. Amanda Fey is the owner and practicing Naturopathic Doctor at Complementary Medicine & Healing Arts, the Southern Tiers Center for Natural Healthcare located in the Binghamton NY area. The office website is www.naturallywell.us. Dr. Fey is currently offering telemedicine for patients all across the US. To contact the office, call 607-729-0591 or email cmhahealth@gmail.com.
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