The TRUTH about Menstrual or Hormonal Migraine Causes

In this blog post we are going to explain how the medical model looks at menstrual migraines, as well as, how we evaluate and treat them differently. 

A menstrual migraine is a type of headache that occurs during a woman's menstrual cycle, typically around the time of her period. These headaches are often characterized by a dull, aching pain on one or both sides of the head and can be accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.

Menstrual migraines can be debilitating and significantly impact a woman's quality of life. Treatment for hormonal migraines may include taking pain medication during the days when migraines are most likely to occur, or preventive measures, such as taking hormonal birth control to regulate hormone levels. 

The exact cause of menstrual migraines is not fully understood, and it is considered a primary headache.

Primary headaches have no known cause for their pain. They include tension-type headaches, various migraine headaches, cluster headaches, and other types of headaches. The critical thing to remember is that the medical community does NOT know what causes the symptoms of the headache.  

Menstrual migraines are believed to be related to hormonal changes during the menstrual cycle, specifically changes in estrogen and progesterone levels; however, this is just one theory. It's important to note that the causes and triggers of menstrual migraines and headaches can be multifactorial and may include other factors such as stress, sleep, diet, and genetics.

How we look at things differently:

One of the proposed mechanisms for developing menstrual migraines is central sensitization. Central sensitization refers to a state of heightened sensitivity in the central nervous system, which can lead to an increased awareness of pain. Central sensitization could explain why headaches could be triggered by normal hormonal changes that occur during the menstrual cycle. Although possible, the specific pathways and factors involved still need to be fully understood. However, this offers hope to headache and migraine sufferers.

A proposed theory for central sensitization in menstrual migraines is a sensitized trigeminal cervical complex (TCC). The TCC refers to the interconnected network of nerves and muscles responsible for the sensation and movement of the head and neck. The TCC is located in the upper neck area, near the brainstem. The TCC includes the three branches of the trigeminal nerve (oculomotor, maxillary, and mandibular) and the first three cervical nerves (C1-C3). The TCC is responsible for integrating the sensory information from the face and cervical region and relaying it to various brain regions for further processing.

The trigeminal nerve, also known as the fifth cranial nerve, is responsible for the sensation of the face, head, and jaw. It is divided into three branches: oculomotor, maxillary, and mandibular. The oculomotor branch innervates the eye muscles, the maxillary branch innervates the skin of the face, and the mandibular branch innervates the jaw muscles.

The cervical nerves, specifically C1-C3, are responsible for the sensation and movement of the neck and upper shoulders. 

The C1 spinal nerve or cervical nerve 1 originates from the spinal cord in the neck and exits the spinal column between the skull and the first cervical vertebra (C1). It is the most superior spinal nerve in the cervical region, and it innervates the uppermost muscles of the neck and the back of the scalp. It provides sensation to the back of the head and the upper neck. Also, it controls the movement of the head.

The C2 spinal nerve or cervical nerve 2 originates from the spinal cord in the neck and exits the spinal column between the first and second cervical vertebrae (C1 and C2). C2 innervates the muscles that control the movement of the head, such as the splenius capitis, semispinalis capitis, and the upper fibers of the trapezius muscles. It also provides sensation to the back of the head and the upper neck. 

The C3 spinal nerve or cervical nerve 3 originates from the spinal cord in the neck and exits the spinal column between the second and third cervical vertebrae (C2 and C3). C3 innervates the muscles that control the head and neck movement, such as levator scapulae, splenius cervicis, and the upper fibers of the trapezius muscles. Also, it provides sensation to the skin of the neck and the upper shoulders. 

Cervical afferents are sensory nerve fibers that transmit information about sensations in the cervical region of the body to the spinal cord and brain. These fibers can be activated by light pressure, temperature, and pain in the cervical region and send signals to the TCC. 

The above explains how the neck and the upper three cervical nerves can play a role in menstrual migraines and headaches. The neck is connected to the brain through the spinal cord. Problems in the neck, such as joint stiffness, muscle tension, poor posture, or injury, can affect the TCC and contribute to headaches and migraines.

A sensitized TCC is a state in which these nerves and muscles become overly sensitive, leading to an increased perception of pain and discomfort. Various factors, including injury, inflammation, or chronic conditions such as migraines, can cause the TCC to become sensitized. 

In the case of migraines, sensitization of the TCC by the upper cervical nerves can lead to increased pain and sensitivity to light, sound, and smell.

A sensitized TCC is like a ticking time bomb going off. Please think of the neck as the sensitizing nerve center at the bottom of the brain, and the hormonal changes themselves are only a small part of the problem. 

Imagine a glass filling with water. The sensitized nerves are like a dripping faucet that, over time, fills up a glass with water to 85 and then 90%. Then during the menstrual cycle, the hormonal changes push in more water, causing the water to overflow from the glass. It was the little extra input from the hormonal changes that caused the overflow or headache to happen. This is an interesting concept, and it is essential to consider neck and spinal issues in assessing and treating menstrual migraines and headaches.

Here are a few hints that the neck contributes to the onset of menstrual migraines and headaches.

  1. If the headache is on one side and can switch sides: If the headache is moving around, the neck is a prime suspect. The neck joints and muscles can be stiffer on one side one month and more rigid on the other side another month, which causes the headache to be on the right or the left.

  2. If the headache is locked to one side: If it's a genuine hormonal issue, the hormones will impact both sides of the body. Suppose the headache is locked to one side. In that case, it's worth having your neck assessed to see if the neck is driving this pattern and if the hormones are more of an innocent bystander.

  3. If other medical interventions haven't worked: If you've had your hormones looked at, and they're normal, if you've had other medications that you've tried, or if there are other interventions that you've tried, like birth control medication and nothing seems to work, then it's essential to have the neck assessed because it might just be the missing link in the puzzle.

It is important to note that not all women experience menstrual migraines, and those who do may experience them differently. Some women may only experience migraines during their menstrual cycle, while others may experience migraines throughout the month. Additionally, menstrual migraines are a subtype of migraine, a neurological disorder characterized by recurrent episodes of moderate to severe headache pain, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.

The treatment of menstrual migraines can vary depending on the individual and the severity of their symptoms. Over-the-counter pain medications such as ibuprofen and naproxen can effectively manage the pain. For those with more severe symptoms, prescription medications such as triptans may be needed. Some women may also find relief from natural remedies such as ginger, feverfew, and magnesium supplements.

OUR SOLUTION, how we treat headaches and migraines:

For us at OneAccord, we have one question we need to answer: "Is your cervical spine driving your headache and migraine symptoms ?"

If it is, we are the perfect place for you. 

At OneAccord, we are internationally trained and follow a rigorous process to determine if your cervical spine or a sensitized trigeminal cervical complex influences your headache or migraine. 

The critical step in diagnosing a cervicogenic (neck-related) headache is to have a skilled examination of the neck by someone trained to determine the following:

  1. Is the upper cervical spine the driver of your headaches, and will it respond to our protocols? Answering the question: "Can we reproduce and reduce your headache symptoms within our evaluation?" If so, you are the perfect patient with whom we get the best results.  
  2. Which segment(s) specifically are responsible for your referring headache symptoms?
  3. If you are ready to engage in our headache recovery program full and follow our expert advice.
  4. Provide treatments to help de-sensitize the trigeminal cervical complex and reduce pain input from identified segments.
  5. Create a patient-specific plan of care that includes segment-specific home exercises, activity modification, and lifestyle medicine coaching, which may consist of behavior change, sleep, stress management, and nutritional changes for long-term success. 

Our process includes three phases:

1. An intake questionnaire and a thirty-minute telemedicine visit with our headache and migraine specialist. 

    a. This will indicate if you would benefit from an in-person examination. This includes a detailed history of your headaches. 

   b. Next, we will map out the area of the headache and analyze the behavior of the symptoms.

2. Phase 2 is a 1-hour in-person visit usually covered by most insurance. During this visit, you will experience the following:
We will perform a physical examination of the neck to reproduce and lessen the headache temporarily. This vital step tells us if your specific presentation will respond to our treatment strategies. 

During this visit, we will tell you:
     a. Why you are having symptoms.
     b. How long will it take to see an improvement (typically 4-6 visits).
    c. How you can immediately start helping yourself.
    d. How we can help you achieve your goals. 

3. Phase three is our ongoing headache and migraine program. Typically patients are seen 10-12 times over a 3-6 month period. 
Ideally, patients are seen twice a week for 2-3 weeks, depending on their unique presentation.

Frequency is reduced as we see positive results to one time a week, or every other week or monthly, depending on how well you respond to treatments and comply with your home program. 
We assess the cervical spine every visit and update our treatment goals and home exercise program.

Every visit will include a critical aspect of lifestyle medicine coaching, as we know from experience that non-physical factors such as sleep, stress, and nutrition play a role in the long-term success of our patients. 

Please click here to visit our headache and migraine page and to schedule your telemedicine visit with one of our experts.  


Dr. Sean Flannagan Dr. Sean Flannagan, PT, DPT, Cert. SMT, Cert. DN, Cert. VRS Dr. Sean Flannagan is the founder of One Accord Physical Therapy and has a great passion to see both his patients and employees live fulfilled healthy lives. He built One Accord with a patient-centered philosophy and One Accord is now one of Arizona's only teaching and learning clinics in the state. Come experience the One Accord difference. As we like to say: "You have drugs, surgery, or . . . US." We look forward to being a part of your recovery experience.

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