Migraines are approximately three times more common in women than in men after puberty, and the primary reason is hormonal. Fluctuations in oestrogen levels across the menstrual cycle, during pregnancy, and through perimenopause are one of the most reliable and well-documented migraine triggers.
For women who experience hormonal migraines, light sensitivity during an attack is often severe. The photophobia can persist for hours or days after the headache resolves, and in some women it becomes an ongoing background sensitivity between attacks, not just a feature of the attack itself.
Why oestrogen fluctuations trigger migraines
Oestrogen influences the levels and sensitivity of several neurotransmitters in the brain, including serotonin, which plays a central role in migraine pathophysiology. The drop in oestrogen that occurs just before menstruation lowers serotonin activity, which reduces the brain's threshold for the spreading wave of neurological activity that triggers a migraine attack.
This is why menstrual migraines (attacks that occur in the two days before or three days after the onset of menstruation) are typically more severe, longer, and more resistant to treatment than attacks at other times of the month. The low-oestrogen environment essentially makes the brain more reactive to all triggers, including light.
Perimenopause and changing migraine patterns
For many women, migraines worsen during perimenopause, the transition period leading up to menopause. Oestrogen levels during this phase are more variable and unpredictable, fluctuating widely rather than following the regular monthly pattern of the reproductive years. This irregularity increases the frequency of the oestrogen drops that trigger attacks.
Light sensitivity often worsens during perimenopause even in women who have managed their migraines reasonably well for years. If you have noticed your photophobia becoming more persistent or your migraines becoming harder to manage, a change in the hormonal landscape may be part of the reason.
What an optometrist can offer
The hormonal aspects of migraine are managed by your GP or gynaecologist. But optometry plays a practical role in managing the visual component of hormonal migraines:
- Checking whether any uncorrected vision problems are adding to your trigger burden
- Assessing and managing light sensitivity with FL-41 tinted lenses
- Identifying and treating dry eye, which is common during hormonal fluctuations and can worsen visual discomfort during migraines
- Checking binocular vision, which can deteriorate during a migraine attack and contribute to the visual disturbance
FL-41 glasses for hormonal migraines
FL-41 lenses filter the blue-green wavelengths that most strongly activate the pain-sensitive light pathways in the brain. For women with hormonal migraines and significant light sensitivity, wearing FL-41 glasses during the pre-menstrual window or during perimenopause can meaningfully reduce the intensity of photophobia and the frequency of light-triggered attacks.
At Prime Optometrists Auburn, we see many women managing ongoing migraine and light sensitivity and can discuss whether FL-41 lenses are appropriate for your situation. We serve patients from Auburn, Berala, Lidcombe, Granville, Merrylands, Parramatta, Strathfield, Burwood, Campsie, Bankstown, Ashfield, Leichhardt, and across Western and Inner Western Sydney. Book online or call (02) 9761 0005. We are at 43 Auburn Road, Auburn NSW 2144.