PCOS and Migraine: What’s the Connection?

PCOS and Migraine: What’s the Connection?

Polycystic ovarian syndrome (PCOS) and migraine have a lot in common: Both are complex, invisible, chronic conditions that can be incredibly challenging to live with. What’s more, there is ample research to show a clear connection between the two. While not everyone with PCOS will experience migraine, PCOS and associated conditions (like sleep disorders) can make some people more prone to migraine.

For those who experience migraine with PCOS, headache pain and symptoms can be severe or debilitating and cause real disruptions to life, work, and relationships. There are, however, a variety of science-backed strategies to help prevent or ease chronic pain and symptoms. This article explores the links between PCOS and migraine, and offers expert tips to help you live better with both conditions.

What Are Migraine and PCOS, Exactly?

Polycystic ovarian syndrome is a lifelong health condition that affects your hormones. PCOS has features that may include excess immature follicles (or eggs) seen on ultrasound and excess male hormones (testosterone) on blood work. PCOS tends to come with symptoms including irregular periods, unwanted hair patterns, infertility, weight gain around the abdomen, acne, scalp hair thinning, and mood swings. While it’s often overlooked or misdiagnosed by the medical community, PCOS affects at least 10 percent to 20 percent of all women globally.
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Many people think of pain as a core symptom of PCOS, but it’s actually not very common. (If you are experiencing severe abdominal pain, it could be a sign of something else like endometriosis.) For women who have migraine and PCOS, however, the pain often associated with migraine attacks is a distinct exception.

Migraine is a complex neurological disease with many symptoms, often including moderate-to-intense pulsing, throbbing, or burning headache, often on one side of the head. The headache can go on for hours or days and be accompanied by whole-body symptoms, including body aches and pain, nausea, vomiting, and sensitivity to light, touch, or sound.

A migraine attack has several phases or stages. Some people with migraine develop a warning symptom known as an aura, which can happen before or during the headache pain phase of a migraine attack. An aura is a unique cluster of nerve-related symptoms that can include seeing flashing lights, experiencing temporary blind spots, feeling tingling in your face, or having difficulty speaking.

Migraine Is More Common in Women

Women are about three to four times more likely to experience migraine than men.
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One reason may be dips and spikes in the sex hormone estrogen. It is expected that testosterone (another sex hormone) rises in women right before their period, which can then cause a corresponding rise in estrogen as your body tries to balance your hormones. Menstrual migraine is a migraine attack that occurs just a few days before or during your period when your estrogen initially drops.
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Combination birth control (estradiol and progesterone) may increase headaches or migraine attacks in some women when taking the hormone-free portion of birth control packs (i.e., the sugar pills or inactive pills part of the pack). That’s because your estrogen levels go down when you take the sugar pills instead of the hormone pills.
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Ironically, a modified birth control dosing method can be a helpful treatment for menstrual migraine for many women. (See the “Migraine Care Options” section, below.)

So, What’s the Link Between PCOS and Migraine?

Studies have shown a much higher rate of migraine in women with PCOS compared with women without PCOS: 34.2 percent versus 24.7 percent, respectively, to be exact.
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Keep in mind, women with PCOS often have several other health conditions that can also up their risk of migraine. One example is a condition called insulin resistance, which makes it harder for your body to control blood sugar levels. Whether you have an insulin resistance diagnosis or not, blood sugar swings can act as a potent migraine trigger. That’s why it’s so important to avoid skipping meals if you live with migraine.
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Other examples include overweight, obesity, and sleep disorders. In general, poor sleep is common with — and can worsen — both migraine and PCOS. A study published in Sleep and Breathing found 35 percent to 50 percent of women with PCOS have sleep apnea, for example, which is characterized by snoring, high blood pressure, and morning headaches.
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 In fact, high blood pressure in itself often goes hand in hand with migraine, and 19.2 percent of women with PCOS have high blood pressure, according to a study published in European Journal of Obstetrics & Gynecology and Reproductive Biology.
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Birth Control and Migraine

Another possible link between migraine and PCOS? Your birth control regimen. Birth control is a core treatment for many people with PCOS and, when birth control medication — or its dosing — isn’t carefully tailored to PCOS needs, it can contribute to migraine.

“I experienced ocular, or eye, migraines with aura [numbness, tingling, vision changes, ER visits] every month before my period,” says Jazzmine Santiago, a person with PCOS undergoing treatment at PCOS Sisters Telehealth Clinic in Florida. “I was given different birth control options for years as a treatment that only made my migraines worse.”

“I needed a personalized treatment plan,” she continues, “one that recognized estrogen-based birth control is not the answer in my case because all PCOS patients are different and require a personalized approach. I have experienced resolution of my migraines by treating my PCOS with [the weight loss medication] semaglutide and a progesterone-only birth control. This combination has been life-changing! I now rarely experience migraine. For breakthrough headaches, I take ibuprofen as soon as I sense an aura and lay down in a dark room until it passes.”

Note: Do you have aura with your migraine? Some prescribing exceptions might apply to you, so it’s essential to partner with a trusted clinician and have an open conversation about your symptoms. With aura, estrogen-based birth control (combination birth control pills) can increase the risk for stroke and currently is not recommended. If you experience migraine with aura, you might need a progesterone-only birth control.
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Migraine Care Options for Women With PCOS

Because PCOS can influence migraine patterns, many people end up exploring treatment options that address both conditions by targeting PCOS-related hormone changes. Below are some of the approaches most often used.

Explore the Possibility of Low-Dose, Continuous Birth Control

While some people with PCOS avoid birth control (possibly due to past negative experiences with improper dosing), it can make a world of difference when you finally find a safe and appropriate birth control regimen for you. Low-dose, continuous birth control — taken according to a careful schedule that you set with your clinician — is one way to help keep your hormones steady.

What do we mean by “continuous”? This means taking active pills every day (i.e., the hormone pills) — instead of switching to the inactive pills (i.e., the sugar pills that come with most birth control packs) during your period. Most people take a sugar pill during their period because they don’t need to worry about getting pregnant; but with migraine, you still need to keep your hormone levels steady.

To take this approach, you will have to work closely with your prescribing clinician and your pharmacist to make sure you have enough pills for a continuous supply (since this is not how birth control is typically prescribed).

“I have seen a huge reduction in migraine since starting low-dose, continuous birth control,” reports Marissa Munley, a person with PCOS undergoing care at PCOS Sisters Telehealth Clinic in Florida. “My pro tip? When I do have a breakthrough migraine, I found my trigger is heartburn and beef grease. I will prevent heartburn by taking over-the-counter heartburn medicine, such as Prilosec, before eating triggering foods.”

Know That Birth Control Is Not Your Only Treatment Option

If you haven’t had great experiences with birth control as a person with PCOS, know that there are other drug categories that might work for you.

Medications to help keep your blood sugar and PCOS stable, called insulin sensitizers (like metformin), can reduce migraine risk by balancing hormone levels.

Likewise, a specific class of medications called GLP-1 agonists can balance hormones while helping you lose weight. In fact, semaglutide, the active ingredient in Ozempic and Wegovy, was added to the 2023 international PCOS guideline as treatment for PCOS.
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For Veronica Randy, a PCOS patient at PCOS Sisters Telehealth Clinic in Atlanta, making the shift from traditional birth control to a weight loss med made all the difference. “I experienced migraines weekly for years,” says Randy. “For me, birth control only made it worse, although I was not taking continuous birth control pills [all active pills continuous with no hormone-free break during week of period], and so migraines were much worse during my period. Migraines nearly completely resolved after two months on Mounjaro and losing weight.”

There is currently a clinical trial testing the effect of metformin on migraine prevention. Explore the study criteria and consider if it might be relevant to your health needs.

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Carry Easy Over-The-Counter Meds

A common class of over-the-counter drugs called nonsteroidal anti-inflammatories, or NSAIDs, like ibuprofen (Advil, Motrin) can help to ease a sudden migraine attack or even prevent migraine if taken a few days before a period-related headache is expected to start.

Pro tip: Keep a migraine diary to track when your headaches occur each month and what your potential triggers could be.

Avoid Foods and Drinks That Can Worsen Migraine and PCOS

For those who have them, diet-related triggers are unique, but common culprits include caffeine, sugars, and highly processed foods. Highly processed foods tend to be ones that come in boxes or fast food bags. While fresh, whole food alternatives aren’t always affordable or available to everyone, it can help to start by tackling one highly processed food or drink that you consume all the time.

Shopping sales for bubbly water instead of soda can make a huge difference in cutting sugar and caffeine intake, for example. PCOS-friendly food swaps include switching white bread/pasta for whole grain or wheat versions, swapping high-fat meats like steak and bacon with lean proteins like turkey or fish, and replacing candy with fresh fruit and nuts.

In general, avoid skipping meals and stay hydrated by setting an alarm on your phone for water breaks throughout the day.

Build Exercise Into Your Routine

It’s well known that regular exercise can help to prevent migraine. What can feel more like a mystery is how to reasonably fit exercise into your routine. One simple strategy is to walk for just 15 minutes after every meal. Doing so can help to not only speed up your metabolism but also offset migraine risk.
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Find Your Favorite Stress Busters

Stress is a key contributing factor for both migraine and PCOS, which means stress control should play an important role in your overall care plan. The good news is, certain stress busters can serve to improve sleep and reduce weight gain at the same time. Daily walking, tai chi, and yoga are examples of activities that are simple, low or no cost, and can work simultaneously to improve your mental and physical health.

Treat the Underlying Cause

Sometimes, the best solution is to treat PCOS-associated conditions that are also known to trigger migraine, such as high blood pressure, obesity, and sleep apnea. If you have one of these conditions as well, it’s worth asking your clinician whether it could be contributing to migraine. If you don’t yet have a women’s health or primary care clinician, explore a PCOS specialist like PCOS Sisters Telehealth Clinic.

Make a Migraine Action Plan

It’s important to know exactly what you’ll do if/when an acute, or active, migraine attack happens to you. Migraine can come on quickly and unexpectedly — often at inconvenient times and places. That’s why it’s so important to speak with your clinician in advance and think through whether you should have quick-acting medications on hand to help ease or stop a severe migraine attack.

In addition to over-the-counter NSAIDs like ibuprofen or naproxen, a class of medications called triptans (Imitrex and others) can help to stop a migraine attack after it starts. Triptans are available in pill form, oral dissolving tablets, as nasal sprays, or even quick-acting injections. You will need a prescription to access this class of meds.

For many people, nonmedication steps will be a key part of an effective action plan as well. These steps can include finding a dark place to lie down, eating a quick snack to boost your blood sugar, applying a cold compress to your eyes, or rubbing peppermint oil on your temples. Some people will want to explore menstrual migraine treatment options as well.

Final Thoughts

We’re still learning about the connections between migraine and PCOS, but we know hormone ups and downs are a big part of it. Don’t forget that people with PCOS often have other things going on that can trigger migraine, like high blood pressure, poor sleep, and blood sugar fluctuations. The good news is that these issues usually get better or even clear up once you have a strong PCOS care plan in place.

For people with both conditions, an ideal care plan would include PCOS and migraine treatment strategies. This might mean continuous low-dose combination or progesterone-only birth control, insulin meds like metformin, or weight control meds like GLP-1s. And of course, a healthy diet and exercise plan. It’s important to find a PCOS specialist who can create a personalized approach for your PCOS-related migraine attacks as well.

If you experience migraine and also have symptoms of PCOS, it is worth taking the time to complete a free online PCOS screening assessment. If positive, it is recommended you schedule a visit with a PCOS specialist to provide a PCOS diagnosis and receive treatment. PCOS diagnosis can be established easily with blood work and a medical visit.