Ask an expert

11 Aug 2010

Hormonal Migraine
In light of the article here re hormonal migraine - if it widely accepted that this type of migraine is triggered by low Serotonin levels in the body that occurs at that time of the month, then surely a Serotonin supplement is recommended for sufferers, as way of prevention, rather than the use of migraine medication, as way of treatment?

I am one such sufferer, and my doctor has recommended that I do not take the " inactive"  pills of my contraceptive medication, but rather continue only with the " active"  pills. Since the recommendation is to have a period 4 times a year, what I am finding is that my migraine is a lot more intense than the previous monthly migraine I was having.

What is your recommendation re Serotonin supplements?

Answer 455 views
Headache expert
Headache expert

01 Jan 0001

Dear Donna,

Altered serotonin levels have been found in some migraine patients, but not in others. People given serotonin sometimes improved, but the problem is that serotonin affects many organs, so there are too many side effects for it to be effective. Imigran was developed from serotonin to have fewer side effects, but even that only helps some patients. Most patients with hormone related headaches have normal, regular menstrual cycles, meaning that there is nothing wrong with their hormones. The problem is that your body is reacting abnormally to the normal hormonal changes that take place during the menstrual cycle. The answer is to find out why this is happening. To get to the root of the problem, you need what is called a “multidisciplinary assessment”, which should include a neurological examination to rule out any serious underlying condition. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.