Q: How can menstruation and menopause trigger attacks?
A: During the last fortnight of the menstrual cycle, the level of estrogen (a female hormone) gradually decreases. This withdrawal directly affects brain cell function and can trigger a migraine attack. During menopause, a woman’s body produces estrogen and progesterone (the sex hormones responsible for reproduction) more erratically. The disrupted estrogen can trigger migraine. Following menopause, estrogen and progesterone levels are consistently low, hence migraine can improve.
Q: Why can missing a meal or eating too many carbohydrates cause an attack?
A: Missing a meal can lead to hypoglycemia (low blood sugar). It is thought that hypoglycemia triggers migraine by causing the release of epinephrine and other hormones associated with the stress response. These hormones lead to an increase in the blood sugar levels. The body then releases insulin to bring these levels down, which may fall too much. Eating too many carbohydrates has a similar effect, in addition to increasing blood sugar levels.
Q: How does dehydration trigger a migraine attack?
A: The most likely explanation is the same as with hypoglycemia (see Why can missing a meal or eating too many carbohydrates cause an attack?). Any threat to the normal function of the brain and body can cause a stress response.
Q: Why do I have a migraine attack when I stay up too late or sleep too late?
A: The body’s biological cycles are regulated by the hypothalamus, which controls release of serotonin, which induces sleep, and epinephrine, which has an activating effect. In migraine, due to a disturbance in serotonin activity, epinephrine release is poor. This is the most likely reason why sleep disruption can trigger migraine.

Myth or truth?


“Menstrual migraine is unavoidable”


Although menstrual migraine is the result of an internal trigger—the drop in estrogen levels just before menstruation—it is more likely to occur or to be more severe if other triggers are also present. Therefore, avoiding other triggers, such as sleep disturbance or missing a meal, is just as important for those with menstrual migraine as it is for anyone with migraine. By controlling the number of triggers present during the week before menstruation, menstrual migraine can be more easily treated or possibly avoided completely.

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