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I hear from many underactive thyroid/hypothyroidism/Hashimoto’s patients who also experience migraines. Some frequent, some every now and then.
But what’s the link?
Today is the third day in a row that I’ve had a migraine, but the only one that’s not been helped by my regular medication for them. I used to get migraines this often about four years ago, until I came off the combined contraceptive pill and started avoiding caffeinated drinks such as tea.
This double targeted approach meant that my migraines reduced to just one a month, which coincided with the first or second day of my period. Even these started to become less and less frequent as my thyroid levels, sex hormones and other parts of my confused body started to iron out, but lately, I’ve had a sharp increase in them again and I’m unsure as to why.
This eye mask is an interesting addition to my migraine routine, though. Just look at it! My routine when a migraine attack occurs: I take Sumatriptan (my prescribed migraine meds), drink water, lie in a cool, quiet room and make it as dark as possible with an eye mask. If the pain is at its worse, I also need a hot water bottle on the side the pain is (it’s always behind one eye for me) and a bucket for the nausea in case I’m sick.
I don’t get the ‘aura’ that many others get with my migraines, but do get the horrendous pain (I can’t compare anything else to it), nausea (I’ve been physically sick with migraines in the past too), dizziness and spinning room. I then just have to wait it out and after, I’m left with the ‘migraine hangover’ for a day or so afterwards.
The above is a post I wrote and put on my social media pages back in March of this year, which received a lot more responses than I expected. I heard back from other thyroid patients all over the globe, of all ages, who shared their similar experiences with migraines and thyroid disease.
Like me, some stated that avoiding caffeine and coming off hormonal contraceptives helped them stop or lessen the frequency of the attacks, but for others, they also shared that they had great success trying other routes. Going gluten free, dairy free, avoiding triggering alcohol such as wine, getting a daith piercing, addressing high blood pressure, treating nasal polyps, taking magnesium supplements and even getting their bowels moving more regularly, were all also stated in helping thyroid patients with their migraines.
But is there any known links in all of this? Whilst some specific substances or issues are known to be connected to migraines, i.e. caffeine and oestrogen, what is the connection? And what can we do to help ourselves?
Let’s start with what a migraine is.
I migraine is more than a regular headache. Migraines are debilitating and are often not helped by regular painkillers such as paracetamol or ibuprofen. The pain often felt behind one eye or on one side of the head is a deep, distracting throbbing that is often accompanied by nausea, disturbed vision, sensitivity to light, sound and even movement. Some people also feel dizzy and faint with a migraine.
Migraines are often thought to be caused by the expansion of blood vessels in the head, which is how medication such as Sumatriptan (what I’m prescribed for them) works. They narrow the blood vessels in the head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, lack of appetite and other symptoms of migraine. For many, these medications are a lifesaver so that we’re not completely disabled by an attack and can carry on our day as normally as possible. However, for some, these medications don’t work, suggesting that the cause for migraines aren’t completely understood yet or the same for each person.
Pain induced by a migraine can last anywhere from hours to days. A ‘migraine hangover’ is also a term you may have heard, for the fuzzy, unwell feeling that many people experience for a day or so after the migraine attack. It can cause a lack in ability to concentrate, sensitivity to light and sound and mood swings.
The Thyroid Migraine Link
A study published in Headache: The Journal of Head and Face Pain, suggests a connection between thyroid disease and migraines. It included over 8400 participants, observed over 20 years, and the data collected from the study suggests that those with a pre-existing headache disorder such as migraine, have a 21% greater risk of developing hypothyroidism. Also very interestingly, those already experiencing migraines are a whopping 41% more likely to become hypothyroid!
Hypothyroid patients frequently exhibit a history of migraine issues during childhood, prior to developing hypothyroidism. So this may be an indicator of a predisposition to developing hypothyroidism and a warning of the condition to come.
A study in The Journal of Headache and Pain also found that hypothyroidism was more common in those with migraines than in the general population, suggesting a plausible link between these two health problems.
For many thyroid patients, simply getting their thyroid levels optimal may well help in the frequency of migraines, as it does help to improve a lot of symptoms of hypothyroidism, or remove them altogether, so this shouldn’t be overlooked.
However, if you’re thyroid levels are already optimal (for example, a TSH below 2, Free T3 in the top quarter of the range and Free T4 midrange or higher) and you’re still experiencing migraines, it’d be worth exploring other possible triggers or causes such as those below.
According to the Migraine Relief Centre:
The purely physiological hypothesis posits that inadequate thyroidal function results in a slower metabolism, which in turn causes the body to retain fluid and mucin glycoprotein. This process eventually causes swelling of blood vessels and brain tissue, which can result in cerebral hyperactivity that can trigger a migraine episode.
This suggests further reasoning as to why below optimal thyroid levels and hypothyroidism can lead to migraines, through the slowing down of the metabolism.
A study recently published in Cephalalgia also suggests that subclinical/borderline hypothyroidism is associated with an increased risk for migraine, too. So if your doctor is telling you that you’re ‘only borderline’, you may want to push for treatment further. I hate this term anyway, but more on that here.
The link between hypothyroidism and oestrogen dominance
Is well understood, as is the use of hormonal contraceptives and migraines. The NHS website even lists the contraceptive pill as a known cause for migraines.
I’m one such thyroid patient who, after years on the combined contraceptive pill, with period issues such as menorraghia and irregularity as well as my thyroid issues, found out that I had oestrogen dominance; when the balance of oestrogen to progesterone is very ‘off’, and this is often worsened when taking hormonal contraceptives.
The link between oestrogen dominance and hypothyroidism is hard to miss, considering that for every nine or ten women that suffer from hypothyroidism, only one man does. We also know that big hormonal shifts in a woman’s body, such as pregnancy or the menopause, can bring hypothyroidism to surface. Many medical professionals are now blaming oestrogen dominance for the cause of some hypothyroidism cases, as a none autoimmune cause on its own, but also as a trigger for the autoimmune version of hypothyroidism: Hashimoto’s Thyroiditis. Which 90% of us have.
The biggest improvement I made for my migraines was coming off the contraceptive pill, which my GP wanted me to do immediately, aware that there is a big link between hormonal contraceptives and migraines. The migraines reduced in frequency immediately, demonstrating that this hormonal imbalance of oestrogen and progesterone was the main cause for them. Going forward, I’ve also worked with a functional doctor to address the remaining imbalance that left me with irregular periods, severe cystic acne and hormonal migraines (where I experienced them just once a month, at the start of my period), and this has also helped.
Going back to the patient I mentioned at the beginning of this article, who said that getting their bowels moving more regularly helped to rid them of their migraines, I would think that this would be linked to oestrogen dominance also. Getting your bowels moving regularly helps to eliminate excess oestrogen from the body and one of the key things I have had to work on in fixing the oestrogen dominance was constipation.
Are common in those of us with autoimmune hypothyroidism (around 90% of us with hypothyroidism), and as listed on the NHS website, low blood sugar can indeed be a trigger for migraines too!
I never used to realise the importance of making sure that I wasn’t eating sugar or carb heavy meals without adequate protein, years ago, and this no doubt made my overall health worse, but my blood sugar was all over the place. Learning to control your blood sugar is pretty easy and it’s an easy fix to stabilising your mood and energy levels too. Do you ever feel light headed or faint when you need to eat? Or even hangry (hungry and angry)? It’s quite possible that these are signs of low or wobbly blood sugar, so try to make a more conscious effort of basing meals and snacks around protein rather than carbs and sugar.
Since realising that I needed to adjust my diet to allow more protein and less sugar and carbs, my low blood sugar bouts, irritable moods, groggy feeling and slumps are gone. Except when I have a bad food day and eat lots of sugar.. then it returns and I remember how bad it is! I feel sick, irritable, get a headache and generally just urgh. Just don’t do it.
Many patients also told me that taking magnesium supplements helped to lower the frequency of migraines for them, or even cleared them up completely. I hadn’t heard of this connection before, but upon researching in to it, found quite the link. I already knew that many of us thyroid patients do feel the benefits of taking magnesium supplements for fatigue, constipation and muscle aches and pains, as I’m one of those myself (my doctor loves magnesium for all these reasons), but didn’t think about the link with migraines.
I found research that shows people with migraines often have lower levels of magnesium than those who don’t experience migraines. One study actually found that regular intake of magnesium reduced the frequency of migraine attacks by 41.6% percent and another showed that taking daily magnesium supplements can be effective at preventing period related migraines.
Healthline state that although there are many types of magnesium supplements, magnesium oxide is most frequently used to prevent migraines. You can take it in pill form, with a general recommended dosage of about 400 to 500mg a day.
MTHFR is something else to consider. A mutation that approximately 50% of the population has, MTHFR is linked with migraines as it is one of its most common symptoms.
An Italian study in 2007 looked at all of the published studies on the MTHFR gene mutation and migraines. The studies looked at almost 3000 people with migraines and found that people who had Migraine with aura were significantly more likely to have MTHFR. People who had Migraine without aura had no significant difference from the control group.
What can you do to help in a migraine attack?
What helps you to get through the attack at the time is very individual and I’ve done a lot of trial and error over the years.
Whilst many state that ice packs against the pain helps, I find that a hot water bottle wrapped in towels is much better for me. Heat soothes my pain and helps it pass a lot quicker. A hot shower or bath can also help, but I prefer to stay away from these when I have a migraine due to the safety risk. I wouldn’t want you passing out or fainting where water is concerned!
I also like applying Tiger Balm to the area of my head affected, which helps to soothe the pain so that I can try and get some sleep. Some people also find benefits in acupuncture for their migraine and other thyroid disease associated pain.
If ibuprofen doesn’t help or, like me, once did but just doesn’t do the job anymore, talk to your doctor about prescription meds, which can be a huge lifesaver. If taken at the first sign of an attack, they can prevent the migraine from going full-blown.
You can also try some of the various suggestions that other patients have listed at the beginning of this article, such as avoiding caffeine, coming off hormonal contraceptives, gluten, dairy etc. but it’s all really about what works for you. Figuring out what the root cause for the migraines is and attempting to address that is of course the best way to go.
You can click on the hyperlinks in the above post to learn more and see references to information given.
Written by Rachel, The Invisible Hypothyroidism
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Rachel Hill, Thyroid Patient Advocate, blogger and author, has Six 2018 WEGO Health Award Nominations. She is a highly ranked writer appearing in the Top Hypothyroidism Websites and Top Thyroid Websites and has worked with The National Academy of Hypothyroidism, The BBC, The Mighty, Yahoo, MSN and ThyroidChange, to name just a few. She is well-recognised as a useful contributor to the thyroid community and also contributed the foreword to Emily Kyle’s The 30-Minute Thyroid Cookbook.