Menstrual Migraine Headaches: Do you suffer?
Most people associate symptoms of photophobia (sensitivity to light) and phonophobia (sensitivity to noise), one sided headache, as well as aura, as necessary symptoms of a migraine headache. The International Headache Society (international classification of headache disorders) has classified a migraine headache to include any two of the following symptoms:
- Moderate to severe pain
- Throbbing nature
- Unilateral location
- Intensification upon activity
Studies have shown that up to 13% of Americans suffer from migraine headaches of which the majority are women.
We, as gynecologists, are most sensitive to this problem because many patients only experience migraine headaches during their menses or their migraine is exacerbated by menses. This is defined as menstrual migraines. These patients have often seen neurologists and are using medications such as non-steroidals (e.g. Advil), Triptans (e.g. Imitrex, Relpax) or Butalbital, all of which can be beneficial. Menstrual migraines on the other hand often are a result of hormonal changes in the menstrual cycle and the gynecologist can be extremely successful in preventing menstrual migraine by incorporating different hormonal regimens.
Menstrual migraine is brought on by the precipitous drop in Estrogen a few days prior to the onset of bleeding (menses). Different hormonal strategies in one study prevented migraines in 73% of patients treated (Headache Journal). Other studies have shown success in over 50% of the patients treated. The mainstay of preventive treatment is to stabilize the levels of Estrogen through supplementation during these days.
The simplest case is a young woman who desires birth control. She will use either continuous cycle pills (eliminating periods altogether) or supplementing Estrogen during the placebo week of pills – both work well (results in cyclic menses). Women who are not in need of birth control can supplement Estrogen beginning 2-3 days prior to expected menses for a period of only 7 days. This supplementation can be used in the form of a patch, a gel, or an oral tablet!
The take home message: First, know what constitutes a migraine headache. If it occurs or is exacerbated by menses, the headache can most often be prevented with proper hormonal treatment!
Headache Journal. (2008). issue 4, 1186-93.
