Many women sufferers often relate their migraine attacks to the menstrual cycle. If the week before is considered premenstrual and the week after post-menstrual, then three of the four weeks of the cycle could be thought of as closely related to menstruation, and it is not surprising that the majority of attacks should occur during that period. However, the action of the female hormones (oestrogen and progesterone) on blood vessels in the lining of the womb during the menstrual cycle is of great relevance to migraine. The uterine blood vessels become elongated, twisted, and thick-walled, and similar changes occur elsewhere in the body. If the level of progesterone drops suddenly, bleeding occurs from the womb, and headaches are more frequent. This is the pattern of pre-menstrual migraine and it is for this reason that progesterone supplements have been given for the prevention of migraine attacks at this time.
Some women have headaches a week before their period; others have them on the first day or during the last days of their period; yet others get them at the time of ovulation i.e. midway between the menstrual periods.
Before the menstrual period, women often complain of increased weight due to water retention. This, too, has been associated with migraine attacks and, not infrequently, the disappearance of the attack is marked by an excessive excretion of urine.
Headaches may become more frequent and troublesome at puberty, and this also is probably related to hormonal changes. In adult life, there is a tendency for headaches to get better with increasing age, but this is not consistent and some women may get a worsening of the headache about the time of the menopause. Eighty per cent of women who suffer from headaches lose them during pregnancy although, in some, headaches may become worse in the early stages.