Hormonal Migraines and the Menstrual Cycle (Episode 611)

Lisa: I’m really excited to be here today with Dr. Meg Mill. Welcome to the show, Dr. Mill.

Dr. Meg Mill: Hi, thank you for having me.

Lisa: Thank you for being here. I’m really excited to talk about migraines. It’s one of those topics that isn’t talked about much, perhaps because it’s so common. People often assume it’s just something to live with. So, to get us started, I’d love to hear a bit about your background. What do you do, and what led you to focus on this area?

Dr. Meg Mill: I’m a functional medicine practitioner with a virtual practice. I work with patients worldwide for a variety of issues. What I noticed was that many of my clients—mostly women—either came in specifically for headaches and migraines or mentioned them casually on their intake forms. It was so common, many didn’t even see it as an issue. But once we started working together, the results were often life-changing. Migraines went away or significantly reduced. That’s when I realized we need to talk more about this issue.

Lisa: That’s so interesting. Before we go further into migraines, could you talk a bit about the difference between conventional and functional medicine?

Dr. Meg Mill: Sure. Conventional medicine is great for acute care—things like infections or emergencies. Functional medicine focuses on root causes. We ask why symptoms are happening in the first place. When it comes to migraines, we look beyond the head and consider the whole body—diet, sleep, hormone balance, and so on.

Lisa: Let’s dive into that. What is a migraine exactly? How is it different from a regular headache?

Dr. Meg Mill: A migraine typically lasts longer and has more symptoms—throbbing pain, light sensitivity, nausea, sometimes aura. Tension headaches are more like a band across the forehead. Migraines often come in patterns, especially with hormonal shifts.

Lisa: That’s a good point. Many of my clients have no idea their migraines could be tied to their cycles until they start tracking. What are some common migraine triggers you see in your work?

Dr. Meg Mill: Genetics can play a role—like variants in the DAO enzyme that breaks down histamine. Histamine can trigger migraines. Estrogen dominance is another big one. Sleep deprivation and dehydration are also huge. Some people are sensitive to histamine-rich foods, and that may not show up until a day or two later, which makes it tricky to identify the trigger.

Lisa: I’ve noticed that too—people reacting to smells, foods, etc. It’s fascinating how histamine and estrogen are so connected. And I imagine migraines get worse for many women in perimenopause?

Dr. Meg Mill: Yes, absolutely. Hormonal fluctuations during perimenopause can worsen migraines. Estrogen dominance and rapid hormone shifts are common migraine triggers. Many women who didn’t have migraines before may start getting them in their late 30s or 40s.

Lisa: Do you think it’s possible to eliminate migraines through functional approaches?

Dr. Meg Mill: Yes, I’ve seen it many times. It can take time, but many people experience a full resolution or a significant decrease in severity and frequency. It’s about identifying triggers and restoring balance—it’s not instant, but it works.

Lisa: Let’s talk more about hormones and migraines. What have you seen in your clients?

Dr. Meg Mill: Most hormonal migraines happen around ovulation and right before the period. I use the Dutch test to assess estrogen, progesterone, and their metabolites. Sometimes estrogen levels look “normal” in blood tests, but the body isn’t clearing estrogen well, leading to high metabolite buildup and symptoms. Improving estrogen detoxification through liver and gut support is key.

Lisa: That’s so helpful. I’m always reminding people that estrogen dominance doesn’t always mean high estrogen—it can be normal estrogen but low progesterone or poor clearance.

Dr. Meg Mill: Exactly. It’s not always about high numbers. It’s about balance and function. I also recommend reducing endocrine disruptors in products—your skin is like a giant mouth, absorbing everything.

Lisa: Totally agree. We don’t talk about that enough. The average person doesn’t realize how many chemicals are in daily-use products.

Dr. Meg Mill: Right. BPA in plastics is a big one. Switching to glass and using the EWG Skin Deep database to evaluate personal care products can help.

Lisa: Let’s touch on food sensitivities. What’s your approach to identifying them?

Dr. Meg Mill: I use a combination of testing and elimination diets, depending on the person. Some people do great with an elimination diet, others find it overwhelming. I recommend removing the food for about 90 days to clear antibodies and then reintroducing slowly to see how you respond. This isn’t meant to be forever—just enough time to heal the gut and restore tolerance.

Lisa: That’s really helpful. Especially since some people think once they remove a food, it’s permanent. But you’re saying the goal is to reintroduce eventually.

Dr. Meg Mill: Absolutely. The goal is to expand your food list, not restrict it forever.

Lisa: Thank you again for this conversation. Where can people find you and learn more about your work?

Dr. Meg Mill: You can find me on Instagram @drmegmill, listen to my podcast “A Little Bit Healthier,” or download my free guide at helpmyheadaches.com. I also run a group program called Headstrong and work one-on-one with clients.

Lisa: Wonderful. Thanks again for joining us today, Dr. Mill.