Migraines are a common health condition that can cause a severe headache, as well as other symptoms such as nausea, vomiting, and sensitivity to light and sound
A GP has revealed why certain people are more susceptible to migraines than others. The NHS describes a migraine as feeling ‘like a very bad headache with a throbbing pain on one side’.
Sufferers often experience nausea, vomiting and heightened sensitivity to light and sound alongside the pain. Episodes can persist from an hour to multiple days.
Some people experience what’s called an aura beforehand – typically bright flashing lights or a tingling sensation on one side of the face or in an arm or leg.
The exact cause remains unclear, though research suggests both genetic and environmental factors may contribute. Hormonal fluctuations are believed to be significant, which explains why migraines frequently occur before or during periods, pregnancy and the menopause.
A 2023 study claims that ‘one out of every five women of reproductive age suffers from migraine’. Dr Amir Khan, recognised for addressing health matters on television and social media platforms, said: “If your migraines flare around your period, ovulation, pregnancy or perimenopause, let me explain exactly why. It isn’t random, it’s physiology.
“Now, oestrogen doesn’t just control periods, it has receptors all over the brain. It affects blood vessels, nerve sensitivity and the pain processing areas like the trigeminal nerve. When oestrogen is stable, the brain is calmer. But when oestrogen levels drop, suddenly the brain becomes more excitable, more sensitive, and more likely to trigger a migraine.
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“Now, there’s a pathway called the trigeminal pathway, which runs across the face and into the brain, and it’s the main circuit involved in migraines. Low oestrogen makes this nerve easier to activate, so when it fires, it releases chemicals, especially one called calcitonin gene-related peptide, or CGRP. This causes blood vessels to widen, the brain tissues to become more inflamed, and that classic throbbing pain to begin.
“Oestrogen normally helps keep CGRP under control, but when oestrogen levels fall, CGRP shoots up and that amplifies pain signals. This is why the newest migraine medicines target CGRP directly. Now, oestrogen also influences serotonin, the mood and gut hormone. As oestrogen levels drop, serotonin levels can dip too, and that’s why hormonal migraines often come with nausea, mood changes, or light sensitivity. It’s one interconnected system.
“Now, there are three main times oestrogen drop. Now, the first one is just before your period, the steepest drop in oestrogen of the whole cycle. This is the biggest migraine trigger. The second one is around ovulation. A small rise and fall can set things off in a migraine-sensitive woman. And the third one, the big one, perimenopause. Hormones are swinging wildly. One day high, next day low. This is why many women suddenly develop migraines in their 40s or existing migraines can get dramatically worse.
“Now remember, after puberty, women are up to three times more affected by migraines than boys, which tells us this is hormonally driven, not just in your head, and definitely not something to put up with. So if your migraines follow a pattern, whether it’s monthly, pre-period, or during the perimenopause, it’s your hormones interacting with your brain’s pain circuits. And once we can identify your pattern, we can tailor treatment much more effectively.”
