Dr. Olivia Begasse de Dhaem, a board-certified neurologist and internationally recognized headache specialist, joined our Endo Exchange webinar “Endometriosis & the Brain — Hormonal Headaches, Fatigue & the Overlooked Neurology of Chronic Pain” with Dr. Karli Provost Goldstein and patient advocate Audrey Craven. Together, they unpacked how cyclical migraine, fatigue, and neurological symptoms often point to something deeper: a brain-body connection shaped by hormones, inflammation, and chronic pain.
This conversation offered clarity where confusion often reigns—and helped redefine what “normal” should never feel like.
About Dr. Olivia Begasse de Dhaem
Dr. Begasse de Dhaem brings deep expertise in the overlooked intersection of migraine, hormones, and women’s health. As a neurologist specializing in headache medicine, she’s dedicated her career to helping patients understand how their brains respond to hormonal shifts.
She is a trusted voice in neurologic care, working to close the gaps between gynecology and neurology with both science and empathy.
- Board-certified neurologist and headache specialist
- Medical Director, Institute for Headache and Brain Health (Stamford, CT)
- Assistant Professor of Neurology, University of Connecticut
- Vice Chair, Global Patient Advocacy Coalition for Headache (GPACH)
- Co-author of the Oxford University Press book “Headache: what do I do now?”
Contact Dr. Begasse de Dhaem’s Clinic – Institute for Headache & Neurological Care
- 1275 Summer Street, Suite 306, Stamford, CT 06902
- (203) 306-2949
- info@instituteforheadache.com
- instituteforheadache.com
- @headacheandbrainhealth on Instagram
Why Her Voice Matters in Gynecologic Care
Regularly see patient struggle with brain fog, cyclic fatigue, or disabling pain tied to their menstrual cycle—yet they’ve never been offered neurologic care.
We asked Dr. Olivia: Why aren’t gynecologists and neurologists speaking more often?
We’re trained in silos. Neurologists don’t always ask about ovulation or menstrual cycles. Gynecologists may not screen for migraine. But often our patients are already living the overlap.
Migraine is a neurologic disease. Endometriosis is an inflammatory, estrogen-responsive disease. And both can dramatically alter quality of life and function—especially when they’re dismissed, separated, or misunderstood.
Our partnership reflects a shared mission: to validate symptoms, connect disciplines, and build truly integrative care plans that consider the whole person.
Dr. Olivia Begasse de Dhaem Answers Your Top Questions About Gynecologic, Hormonal, and Endometriosis Care in Relation to Headache, Migraine, and Neurologic Health
What patients are asking when their pain, fatigue, or brain fog doesn’t fit neatly into one specialty box — Dr. Olivia Begasse de Dhaem answers the questions we hear most.
What causes my brain fog and fatigue to get worse before my period?
Dr. Olivia Begasse de Dhaem’s Answer: The drop in estrogen seen before menstruation leads to an increased susceptibility to neuroinflammation, cognition changes, mood changes, pain, and headaches. It’s not imagined—it’s neurologic.
What does light and sound sensitivity have to do with migraine?
Dr. Olivia Begasse de Dhaem’s Answer: These are some of the classic signs of migraine. Migraine is a sensory processing disorder. Sensitivity to light, noise, or even smells around your periods may be a sign of migraine.
What does it mean if my scans are normal but I still feel awful?
Dr. Olivia Begasse de Dhaem’s Answer: Migraine is a disease of brain sensitivity, a disorder of function/software. Scans (MRI or CT) are pictures that can look at structure/hardware issues. Migraine doesn’t show up on scans. The diagnosis is clinical and made by history. Sometimes imaging is ordered to make sure no structural underlying issue is getting missed.
What makes hormone therapy risky if I have migraine with aura?
Dr. Olivia Begasse de Dhaem’s Answer: Aura (gradually progressive temporary symptoms often before the headache phase) can signal a slightly elevated stroke risk when combined with oral estrogen and/or smoking. That doesn’t mean you’re out of options—it means we tailor the therapy, often using transdermal estrogen or progesterone-only approaches.
What does perimenopause do to migraine?
Dr. Olivia Begasse de Dhaem’s Answer: Perimenopause brings hormonal chaos—erratic rises and crashes in estrogen. This makes migraine attacks more frequent and harder to predict. Stabilizing hormone levels and addressing neurologic sensitivity are key strategies.
What explains getting a migraine attack on a calm, “good” day?
Dr. Olivia Begasse de Dhaem’s Answer: That’s often what we call a “letdown migraine.” Some of the stress hormones can temporarily be protective against pain. After a period of high stress or hormonal fluctuation, your nervous system drops its guard—and that’s when the attack hits. It’s your body’s delayed reaction to previous overstimulation.
What types of migraine should I know about?
Dr. Olivia Begasse de Dhaem’s Answer:
- Migraine without aura: moderate to severe head pain typically accompanied by nausea, sensitivity to light, sensitivity to sound, and interfering with regular activity.
- Migraine with aura: gradually progressive and transient neurological symptoms such as vision changes, tingling, difficulty with speech
- Chronic migraine: at least 15 days per month with headaches including 8 meeting migraine criteria.
- Menstrual migraine: migraine attack happening from 2 days before day 1 of menstruation to day 3 of menstruation.
Knowing your migraine type helps guide treatment—especially around hormone transitions.
What kinds of things can trigger a migraine attack?
Dr. Olivia Begasse de Dhaem’s Answer:
Migraine is a disorder of brain hypersensitivity. Oftentimes, it is not one trigger involved but a combination of things adding up to reach the threshold that may trigger a migraine attack. Also, some factors that were previously considered as triggers are now thought to possibly be markers of the initial phase of the migraine attack – the prodrome. For example, it may not be chocolate triggering migraine but the early phase of the migraine attack (prodrome) leading to chocolate food craving. Common triggers and/or worsening factors include:
- Hormonal changes (especially estrogen withdrawal)
- Weather changes
- Sleep disruption or oversleeping
- Skipped meals or dehydration
- Bright light, loud noise, strong odors
- Emotional stress—or the release from it
What should I include in a migraine or symptom diary?
Dr. Olivia Begasse de Dhaem’s Answer:
- Record your menses on the same diary as your migraine diary.
- Headache day (and associated symptoms)
- Headache severity on a scale of 0-10/10
- Medication taken for headache if any
This helps reveal patterns—and empowers smarter care decisions.
What should I say if I want a neurology referral from my OB/GYN?
Dr. Olivia Begasse de Dhaem’s Answer: Say, “My symptoms are affecting how I think, feel, and function. I believe there may be a neurologic piece to this. Can we involve a specialist to explore it further?” Your voice is powerful—use it to advocate for full-spectrum care.
More Questions? Explore Resources
La Voix des Migraineux (click “English” in the top right): lavoixdesmigraineux.fr
Migraine Association of Ireland: migraine.ie
American Migraine Foundation: americanmigrainefoundation.org
Bridging the Gap—Together
This conversation is the beginning of something better. At ESSE Care, we believe your care should reflect your whole experience—not just a single symptom or cycle day.
If you live with endometriosis, migraine, PMDD, or unrelenting fatigue—this isn’t “in your head.” It is your head. And there’s help.
Let’s build a future where OB/GYNs and neurologists don’t just coexist—they collaborate.
Because your body is connected. And your care should be too.
