Author: Dr Lysandra Katelaris
Adult Neurologist and Neurophysiologist at Neurology Castle Hill
More Than a Coincidence: Understanding the Link Between Migraine and Endometriosis
Endometriosis and migraine are both common conditions that disproportionately affect women, and growing evidence suggests they may be more closely connected than previously thought.
Endometriosis affects approximately one in seven Australian women by the age of 49, while migraine affects almost five million Australians and is up to three times more common in women than men.
Several large studies have shown that women with endometriosis are significantly more likely to experience migraine than women without the condition. While researchers are still working to understand exactly why this association exists, evidence increasingly points to shared hormonal influences, inflammatory pathways and altered pain processing within the nervous system.
Understanding this overlap is important because recognising one condition may help identify the other, potentially leading to earlier diagnosis, more effective treatment and improved quality of life.
The Hormonal Connection
One of the strongest links between migraine and endometriosis involves hormones, particularly oestrogen.
Oestrogen plays an important role in both conditions. Fluctuations in hormone levels throughout the menstrual cycle can influence the activity of endometriosis and also affect the brain pathways involved in migraine.
Many women notice that symptoms of both conditions worsen around menstruation, when oestrogen levels naturally decline. Women with endometriosis are also more likely to experience menstrual migraine, a subtype of migraine that occurs around the time of a period and is often associated with more severe and disabling attacks.
The influence of hormones may help explain why both conditions commonly emerge during the reproductive years and why symptoms often change during pregnancy, perimenopause and menopause.
Shared Inflammatory Pathways
Inflammation may represent another important biological link.
Endometriosis is characterised by chronic inflammation within the pelvis. The presence of endometrial-like tissue outside the uterus triggers the release of inflammatory chemicals that contribute to pain, tissue irritation and scarring.
Migraine is also increasingly recognised as a disorder involving neuroinflammation and altered pain signalling within the nervous system. During a migraine attack, inflammatory mediators and neuropeptides, including calcitonin gene-related peptide (CGRP), play an important role in activating and sustaining pain pathways.
Although the precise relationship remains under investigation, researchers believe that shared inflammatory mechanisms may partly explain why migraine occurs more frequently in women living with endometriosis.
When the Nervous System Becomes More Sensitive
One of the most compelling theories linking migraine and endometriosis is a phenomenon known as central sensitisation.
Central sensitisation occurs when the brain and spinal cord become increasingly responsive to pain signals over time. As a result, pain may be experienced more intensely, more frequently and for longer periods than would otherwise be expected.
Evidence suggests that central sensitisation contributes to both migraine and endometriosis. It may also help explain why some women experience additional chronic pain conditions alongside these disorders, including fibromyalgia, irritable bowel syndrome and chronic pelvic pain.
Rather than representing unrelated conditions occurring by chance, these disorders may reflect overlapping changes in the way the nervous system processes pain.
Could Genetics Play a Role?
Researchers are also exploring whether migraine and endometriosis share underlying genetic susceptibility.
Both conditions tend to run in families, suggesting that inherited biological factors may contribute to their development. While no single gene has been identified as responsible for the overlap, studies suggest that some of the genetic pathways involved in inflammation, hormone regulation and pain processing may be common to both conditions.
Further research is needed, but genetics may help explain why certain women are more vulnerable to developing both disorders.
Can Treating One Condition Improve the Other?
For some women, successful management of endometriosis may lead to improvements in migraine symptoms, particularly when treatment reduces hormonal fluctuations.
However, the relationship is complex and highly individual. Some hormonal treatments used to manage endometriosis may improve migraine, while others may worsen headache frequency or severity in susceptible individuals.
For this reason, treatment decisions should take both conditions into account. What works well for one woman may not be appropriate for another, highlighting the importance of personalised care.
Why a Multidisciplinary Approach Matters
Both migraine and endometriosis can have a profound impact on physical health, emotional wellbeing, work, relationships and quality of life.
When these conditions occur together, management is often most effective when healthcare professionals work collaboratively. Depending on an individual's symptoms, care may involve gynaecologists, neurologists, pain specialists, physiotherapists, psychologists and primary care providers.
Recognising the overlap between migraine and endometriosis allows clinicians to take a more holistic view of a patient's health rather than treating each condition in isolation.
As neurologist Dr Lysandra Katelaris explains:
"Migraine and endometriosis are distinct conditions, but both involve complex interactions between hormones, inflammation and pain-processing pathways within the nervous system. Recognising these shared mechanisms can help clinicians take a more comprehensive approach to care and may ultimately improve outcomes for patients living with both conditions."
Looking Beyond the Diagnosis
While much remains to be learned about the relationship between migraine and endometriosis, awareness of this connection continues to grow.
For women living with both conditions, understanding that the two may be biologically linked can be validating. It can also encourage conversations with healthcare providers about symptoms that may otherwise go unrecognised.
As research continues to evolve, a better understanding of the shared mechanisms underlying migraine and endometriosis may lead to earlier diagnosis, more targeted treatments and improved quality of life for the many women affected by both conditions.
Author: Dr Lysandra Katelaris
Adult Neurologist and Neurophysiologist at Neurology Castle Hill