Some research suggests that polycystic ovary syndrome (PCOS) is a risk factor for migraine and other diseases. However, the data on this link are incomplete, and scientists do not fully understand it.

This comes from a 2022 cohort study from Finland.

Rates of migraine are generally higher among females than males. Scientists believe this may be due to the changing estrogen levels females experience during the menstrual cycle and after menopause. As PCOS also changes a person’s hormone levels, this may explain the link.

However, this is not the only potential connection between the two conditions. People with PCOS are also more likely to have depression and obesity, both of which are risk factors for migraine.

Read on to learn more about PCOS and migraine.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Early research on migraine and PCOS often did not find a connection between the conditions. However, since then, studies have found a correlation.

A 2022 study in Finland compared 246 people with PCOS with 1,573 individuals without the condition and assessed their symptoms. Migraine rates were significantly higher among the PCOS group.

In the control group, 386 people, or 24.7%, reported having migraine. Among individuals with PCOS, 82 people, or 34.2%, reported having migraine.

Researchers believe that a drop in estrogen levels, known as “estrogen withdrawal,” may explain why some females get migraine at specific times in their menstrual cycle.

Usually, estrogen levels build up in the first half of the menstrual cycle, then begin to drop after ovulation, which occurs roughly halfway through the cycle. For people with hormonal migraine, the withdrawal of estrogen often coincides with an increase in symptoms.

However, the situation is different for those with PCOS. Females also have hormones known as androgens, which are typically higher in males but present in all individuals. In PCOS, the levels of these hormones can become elevated.

Although the body can convert androgens into estrogen, PCOS can cause a cycle of hormone dysregulation that reduces this process. Specifically, it can result in the body converting androgens into estrone instead of estradiol. Estradiol is the most potent form of estrogen, whereas estrone and other forms are weaker.

This may affect migraine development or symptoms, but scientists are not yet sure how.

In addition to the direct effect of estrogen levels, there are some other potential connections between PCOS and migraine.

PCOS raises the risk of some other health conditions. These conditions may occur at the same time as PCOS and migraine. They may play a role in raising the risk of migraine.

For example, PCOS leads to a higher likelihood of obesity and depression, both of which are risk factors for migraine headaches.

The answer to this question will depend on the treatment a person wants to try.

Oral contraceptive pill

Oral contraceptives are typically the first-line treatment for PCOS and help reduce androgen production.

People who experience migraine that worsens due to estrogen withdrawal can also benefit from this treatment. This is because taking the pill stops the rapid drop in estrogen following ovulation. However, as individuals with PCOS do not always experience this, it is uncertain if the treatment will help reduce migraine in those with both conditions.

Some people may find their rate of migraine episodes increases when they start or stop hormonal birth control or that the treatment does not have much impact on their symptoms. A doctor may recommend trying different oral contraceptives if this is the case, as people can respond differently to different formulations.

It is worth noting that people who experience migraine with aura may not be able to take oral contraceptives containing estrogen at all. Aura is a change in sensory perception that can occur before a migraine headache.

Migraine with aura is a risk factor for stroke. As the combined pill may also have links to an increased risk of stroke, doctors may recommend other PCOS treatments for people who experience aura.

Insulin resistance drugs

Other treatments for PCOS focus on insulin resistance, which occurs when cells in the body become less sensitive to insulin and do not take up glucose from the blood as well as they should. This can lead to high blood sugar, which, over time, increases the risk of type 2 diabetes.

One drug doctors use to treat insulin resistance in PCOS is metformin, which a clinical trial is testing as a treatment for migraine. The researchers theorize that the drug may down-regulate pain pathways, but results have not confirmed this yet.

Fertility treatment

People with PCOS who undergo fertility treatment may take hormonal medications to increase ovulation. This can change a person’s hormonal balance, which may result in headaches.

No single “best” type of birth control will suit all people with PCOS and migraine. Some may find that oral birth control pills can both reduce their symptoms and offer contraception at the same time. However, it may take some trial and error to find one that suits a person.

If someone can control their PCOS and migraine symptoms with lifestyle and dietary changes alone, they may prefer not to alter their hormone levels. In these cases, nonhormonal options, such as condoms or the copper intrauterine device, may be preferable.

Whichever option a person chooses, it is important to remember that only barrier methods, such as condoms or dental dams, can protect against sexually transmitted infections.

Learn more about birth control options.

Several lifestyle changes may help with PCOS and migraine, such as:

  • Tracking symptoms: Some people with migraine find they have triggers that can set off a headache, in addition to hormonal changes. Identifying these triggers may help a person manage the condition. People can try keeping a migraine diary or using an app to track their symptoms. They can also consider any relevant factors that could have contributed to them, such as stress, sleep changes, or certain foods.
  • Reducing stress: Stress can be a migraine trigger. Living with PCOS can also be stressful, especially for people who have fertility issues. A stress management plan, including support from loved ones, may help.
  • Maintaining a moderate weight: This is important for people with PCOS, as one of the symptoms can be weight gain. Obesity is also a risk factor for migraine, although it is currently unclear if treating this can also improve migraine symptoms.
  • Eating a nutritious diet: Diet is an important tool for weight maintenance, but it is also important to get enough nutrients. Some studies have linked deficiencies in iron and magnesium with migraine. If a person has a lot of food migraine triggers, they may wish to speak with a doctor about using supplements to fill in any gaps in their diet.
  • Getting vitamin D: Researchers believe there may be a connection between vitamin D deficiency and migraine, although more research is necessary to confirm this. Safe sunlight exposure or supplements can help people get enough daily vitamin D.

In addition to migraine, people with PCOS are also more vulnerable to other types of headaches.

A 2020 study followed 114 people with PCOS and 84 without the condition. People with PCOS were more likely to report headaches than those without, at 72.8% compared with 55%.

Tension headaches were the most common type of headache, with 52.6% of people with PCOS and 33.8% of controls experiencing them. People with PCOS were also more likely to report that headaches were severe enough to affect their professional lives.

The study found that among people with PCOS, overweight was an independent risk factor for headaches.

According to some studies, migraine is more common among people living with PCOS than the rest of the population. However, scientists do not yet fully understand the relationship between the two conditions. Hormonal fluctuations and comorbidities may play a role.

PCOS treatment may help improve migraine, but a person may have to try multiple approaches to control the symptoms of both. Medications, diet, reducing stress, and avoiding migraine triggers may help manage both conditions.