For certain women, menstrual woes go beyond a pesky case of PMS. For them, the start of the cycle can also mean the onslaught of migraines. Sara Gottfried, MD, an integrative physician who is board-certified in obstetrics and gynecology and a faculty member at University of California at San Francisco, has treated throngs of women with menstrual migraines and migraines triggered by hormonal shifts. “Within my patient base over the past 10 years, of about 8,500 women,” says Gottfried, “nearly half experience regular headaches, most of them menstrual or hormonally-triggered migraines.”

For years, the author of the upcoming The Hormone Cure (Scribner, 2013) has been applying what she calls the Gottfried Protocol in her practice. It’s a three-step plan to balance hormones naturally that may ease the suffering of women with migraines triggered by hormonal shifts. It may also help them avoid taking prescription medications. Even finding the right migraine medication can be grueling, says Gottfried, and each comes with its own side effects and cost. To many of her patients, trying natural remedies first has been worthwhile.

For starters, Dr. Gottfried recommends a lifestyle reset. This typically involves reducing intake of what she calls “needle movers” through a diet involving:

  • Eliminating gluten (a protein in barley, rye, and wheat)
  • Limiting tyramine (in certain foods naturally, including aged cheeses, cured meats, tap beer, soy sauce, and sauerkraut)
  • Limiting sugar
  • Limiting red wine

Then she recommends supplements (remember to only take supplements under doctor supervision) to fill any nutritional gaps including:

  • Magnesium
  • CoQ10
  • And possibly, 5-HTP

Thirdly, if these changes have been implemented without improving migraine, medications might then be recommended as a last resort, “at the lowest dose and for the shortest duration,” says Gottfried.

For women whose migraines are triggered by hormonal shifts, she advises having your doctor examine your estrogen/progesterone balance and thyroid, assessing for possibilities including borderline low thyroid hormones.

For women with severe migraines during or around their menstrual cycle (menstrual migraines, which strike when or after the hormones estrogen and progesterone dip lowest), she usually recommends progesterone cream applied to the skin plus assessing the progesterone to estradiol ratio and working with your doctor to get it near 300. If you suffer from menstrual migraine, or your migraines are triggered by hormonal shifts, ask your doctor if these treatment options may be suitable for you.

Let us hear from You: Have You or a loved one suffered from menstrual migraine? How have you found relief?