How Can You Treat A Menstrual Migraine
Since menstrual migraine depends on your menstruation cycle, treatment methods will differ. Many women already regulate their menstrual symptoms with contraception or over-the-counter medication. Some common strategies for treating menstrual migraine include:
- Ice on your head or neck.
- Over-the-counter anti-inflammatory medicines like naproxen or ibuprofen.
- Estrogen supplements.
- Prescription medication like triptans or gepants.
- A CEFALY device that can reduce pain intensity in just one hour.
Pharmacological Management Of Menstrual Migraine
Migraine associated with hormonal fluctuations may respond well to standard migraine treatment approaches including pharmacological and nonpharmacological considerations. Before medications are prescribed and a treatment plan in place, several general principles of care may apply:
Consider evidence-based migraine medications first and assess potential contraindications or intolerance limitations
Encourage lifestyle modifications that may improve headache hygiene
Pharmacological approaches to management of menstrual migraine include acute, preventive, rescue, hormonal, and nonpharmacological treatments. Acute pharmacotherapy for migraine is given to stop pain and treat nonpain symptoms of an immediate attack. Acute treatments may be divided into nonspecific treatments that are used for general pain management, and migraine-specific treatments. Nonspecific treatments include aspirin, acetaminophen, non-steroidal anti-inflammatory drugs , opiates, and combination analgesics migraine-specific treatments include ergotamine, dihydroergotamine, and the triptans. Although the majority of patients with menstrual migraine will respond well to acute therapy only, a subset of patients will require preventive treatment. Acute and preventive treatments proven effective in menstrual migraine are listed in .
Pharmacological Treatments for Menstrual Migraine
|â¢ Medical oophorectomy with or without add-back androgens|
How To Prevent Menstrual Migraines
There is no cure for migraine, but there may be ways to reduce the number of episodes. Anyone with menstrual migraine should try to prevent sudden drops in estrogen levels. A persons options might include:
- Switching birth control types: This might involve taking a different type of pill or opting for an implant, for example. It may be an especially good idea to switch to a continuous form of birth control one that does not involve a weekly break.
- Trying estrogen gel or patches: A doctor may prescribe these for people with regular periods. A person applies the gel or patch before their period to prevent a drop in estrogen.
- Using hormone replacement therapy: This is not a treatment for menstrual migraine it treats symptoms commonly associated with perimenopause or menopause. As an added benefit, a person might find that it relieves their menstrual migraine. However, for some people, it makes migraine episodes worse.
It is important to note that a person who has migraine with aura should not be taking birth control that contains estrogen. In general, anyone who experiences aura should let their doctor know.
Other migraine prevention strategies include:
It is important to be aware of the possible side effects and interactions of any drug or supplement and to consult a doctor before trying a new approach.
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What Vitamin Deficiencies Cause Headaches
Hormonal headaches arent always severe. However, they may be worsened by vitamin deficiencies. The combination of an estrogen level drop and a vitamin deficiency causes serious pain that lasts for days.
- Vitamin D Vitamin D deficiency is one of the most common issues people face, especially if they live without regular exposure to sunlight. In fact, more than 42% of Americans suffer from this deficiency. The lack of sufficient levels of vitamin D can cause headaches and other unpleasant symptoms.
- Magnesium Research found a correlation between magnesium deficiency and headaches. The causes of this deficiency vary. Some people may not get enough magnesium from food while others lose it due to medical conditions. Besides headaches, a magnesium deficiency could cause muscle cramps, high blood pressure, irregular heartbeat, asthma, and more.
- Vitamin B2 This vitamin helps your cells function properly. The deficiency could lead to headaches, migraines, reproductive problems, stomatitis, sore throat, hair loss, and more. According to research, high doses of riboflavin can prevent headaches.
Another important deficiency that could lead to headaches isnt related to vitamins. Its an H2O deficiency. Dehydration is a common problem, which busy women often overlook. Meanwhile, the lack of water could lead to severe headaches. If you are too busy to remember drinking water, consider setting up reminders on your smartphone or laptop.
Daily Magnesium Has A Preventive Effect
I really like magnesium as a natural supplement to take every day to help prevent menstrual migraine, says Hindiyeh. There is evidence to support using magnesium, though the mechanism of action, or the why behind how it improves migraine, is not totally understood, she says. It could be stabilizing cells or decreasing hyperexcitability or neuronal firing, but thats all theoretical at this point, she adds.
A review published in the February 2018 issue of Headache that examined five clinical trials of magnesium for migraine prevention concluded that high doses of magnesium citrate seems to be a safe and cost efficient strategy.
While the Headache review didnt address menstrual migraine specifically, the American Migraine Foundation reports that daily oral magnesium supplement has been shown to be effective in preventing menstrually related migraine, especially in women with premenstrual migraine.
A variety of types of magnesium supplements can be purchased over the counter. You can learn more about the various types on the website Migraine Again, and remember that its always a good idea to talk with your doctor about any supplements you are taking or are interested in taking.
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How The Menstrual Cycle Can Cause Migraine
Women who experience menstrual migraine may be sensitive to hormonal fluctuations experienced just prior to the onset of menstruation. Just before menstruation there is a natural drop in progesterone levels.
The two important females hormones involved are progesterone and estrogen.
Progesterone is a natural steroid hormone involved in the female menstrual cycle that stimulates the uterus to prepare for pregnancy. It is a naturally occurring hormone in the female body that helps a healthy female function normally.
Estrogens or oestrogens , are a group of compounds that are important in the menstrual and reproductive cycles. They are also naturally occurring steroid hormones in women that promote the development and maintenance of female features of the body.
It is important to note that estrogens are used as part of some oral contraceptives and in estrogen replacement therapy for some postmenopausal women.
Throughout the natural menstrual cycle the levels of these hormones fluctuate. During the cycle, the levels of progesterone and estrogens also change in relation to each other. See the image below for how these levels change throughout the cycle.
These fluctuations are normal and part of being a healthy and fertile woman.
Several research studies confirm that migraine is significantly more likely to occur in association with falling estrogen in the late luteal/early follicular phase of the menstrual cycle.
Is estrogen withdrawal the sole trigger for menstrual migraine?
What Causes Menstrual Migraine
There is a link between migraine and falling levels of the hormone oestrogen. The natural drop in oestrogen levels before your period starts is linked to menstrual migraine. Women who have heavy and painful periods have higher levels of prostaglandin , which has also been identified as playing a role in a menstrual migraine.
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What Is Menstrual Migraine
First, letâs make sure weâre all on the same page about what âmenstrual migraineâ actually means. Menstrual migraine is a type of migraine that always happens just before or at the beginning of your period. Apart from that, theyâre no different from any other migraine attacks, although they can be longer and more painful than non-menstrual attacks .
Tips To Prevent Menstrual Migraines
by Patient Advocate
One of the chief triggers of migraine is menses and the hormonal roller coaster that comes with it as the body prepares for another cycle of fertility. When our body has trouble regulating its neuro-hormonal systems, everything is strained, and the symptoms we experience like cravings, moods swings, heavy bleeding, and cramping are the end results of those systems having trouble. Here are nine tips that help restore balance to menses and make them less jarring on our bodies physiology.
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Prevention Tip #1 Get Regular Exercise
One study showed that regular aerobic exercise reduced the frequency of migraines as much as taking the medication Topamax. Other findings suggest that high impact interval training and yoga may have similar effects. Light exercise can also help decrease the severity of menstrual migraines if you can do it right at the onset.
But there are two caveats worth mentioning here. The first is that overexercising can be a migraine trigger in its own right. The second is that exercise can worsen your AFS, especially if its in the more advanced stages. So its important that you assess your exercise routine in the context of your current condition and adjust accordingly.
Protect Your Sleep Stress And Hydration
There is always a stress factor at play when we see migraines and menses interacting. Lower the total perceived and experienced stress your body is experiencing by going through different areas of stress in your life and cutting your load. Get adequate rest so your body has time to repair. Hydration to ensure all the necessary minerals are absorbed into your tissues. With stress reduction, sleep, and hydration your body will begin to regulate itself and heal.
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Oral Contraceptives May Reduce Menstrual Migraine Frequency
There is some evidence to suggest that certain types of oral contraceptive pills can actually reduce the frequency of menstrual migraine and menstrually related migraine, Hindiyeh says.
This doesnt apply to all kinds of oral contraception, so you should talk with your gynecologist, primary care doctor, or neurologist about which ones youd want to consider, says Hindiyeh. There are specific ones that will keep your estrogen level from fluctuating so much, she says.
If youre considering taking oral contraceptives as a means of birth control or to try to improve your migraine symptoms, tell your healthcare provider about your migraine history, says Hindiyeh.
While most headache specialists agree that hormonal birth control is safe for most women with migraine, there are cases where it can elevate the risk of stroke, cardiovascular disease, or deep vein thrombosis , according to the American Migraine Foundation. Women who have migraine with aura, in particular, are advised to talk to their doctors about any additional risk factors for stroke or cardiovascular disease that they may have.
Talk To Your Doctor About Beta Blockers
While triptans battle a migraine once it starts, beta blockers work to prevent the migraine from happening to begin with. Beta blockers were originally created to reduce blood pressure, but they are also excellent at preventing migraines and are regularly prescribed for people suffering from migraines, including those caused by your period. The American Headache Society and American Academy of Neurology considers propranolol, metoprolol and timolol the most effective beta blockers for preventing migraines.
Again, this is something you need to talk to your doctor about. So if migraines are plaguing you, book an in-person visit or telemedicine appointment.
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How Does Vagus Nerve Stimulation Help Those Suffering From Headache Pain
The vagus nerve plays an important role in regulating pain. When stimulating the vagus nerve, pain signals causing the attacks can be blocked, helping provide fast relief and preventing future attacks before they happen.
Experience more headache-free days without worrying about drug overuse or inconveniences associated with injectable, inhalers, and medications.
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What Can I Do To Help Relieve The Symptoms Of A Menstrual Migraine
Do your best to figure out what makes your hormone headaches better or worse. For example, if light causes pain and you feel overheated, stay in a cool, dark room. Additional tips include:
- Keep your blood sugar levels up by eating small, frequent snacks. Never miss a meal.
- Learn relaxation techniques.
- Avoid too little or too much sleep, and keep a regular sleep pattern.
- Change your diet, if needed.
- Avoid stress when you can, and learn how to manage it when you cant.
Your Health Questions Answered
- Answered by: Dr Roger HendersonAnswered: 20/10/2021
Firstly, you usually need to have episodic headaches that last 4 to 72 hours. Episodic headaches are headaches that occur up to 14 days of the month. If thats the case, then answer these three questions: does light bother you when you have a headache, do the headaches stop you functioning normally, and do you feel sick with the headache? If the answer to at least two of the three questions is yes, then you may be experiencing migraine headaches.
Who Gets Hormonal Headaches
Hormonal headaches are tied to higher levels of female hormones. Before puberty, boys get more headaches than girls, according to research focused on cisgender people . After puberty, females are more likely to get headaches. This difference lasts until after menopause.
Women are about 3 times more likely than men to have migraine. About 60% say thereâs a connection between their migraine headaches and their periods.
One small study found that men who got migraine headaches had higher levels of an estrogen called estradiol than men who didnât have migraine.
Anyone who takes certain hormone medications, such as birth control pills or hormone replacement therapy, can get a hormonal headache.
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Migraines Headaches And Hormones
Some people get menstrual migraines, which happen anywhere from 2 days before their period to 3 days after it starts. But periods arenât the only trigger for hormonal headaches. Anything that leads to changes in levels of these hormones could cause headaches or make them worse.
How much hormone levels shift, not the change itself, determines how serious these headaches are.
How Are Menstrual Migraines Treated What Medicines Can I Use
A menstrual migraine is usually treated with nonsteroidal anti-inflammatory medications . The NSAIDs most often used for menstrual migraine include:
These drugs should also be started two to three days before your period starts. Continue taking them throughout your menstrual flow.
Because fluid retention often occurs at the same time as your menses, diuretics have been used to prevent menstrual migraines. Some healthcare providers may recommend that you follow a low-salt diet immediately before the start of your menses.
Leuprolide is a medication that affects your hormone levels. Its used only when all other treatment methods have been tried and havent worked.
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Natural Treatments And Lifestyle Adjustments For Menstrual Migraines
Lifestyle treatments are always tricky to study, since they are hard to control and not as well-funded as pharmaceutical medicine.
Magnesium: Thereâs some evidence that magnesium can relieve migraine pain . In a small preliminary trial, participants took magnesium supplements three times per day starting from Day 15 of their cycle until the start of their next period . This treatment helped decrease the participantsâ total pain and also improved their PMS symptoms . In a randomized control trial where participants received either a placebo or a drug containing magnesium, vitamin B2, and coenzyme Q10, the severity of migraines was lower among those taking the drug, though the number of days in which migraines were experienced was not statistically different from the placebo .
Diagnostic Criteria For Menstrual Migraine
Over the years, migraine that is associated with the menstrual cycle has varied in definition and terminology. Given the evidence that migraine is frequently associated with menses, clinical practice and research requires a systematic approach to the classification of menstrual migraine. Current classifications for diagnosing menstrual migraine as a disorder falls into two separate diagnoses based on the characteristics of the attack and its relation to migraine without aura . The International Classification Criteria Appendix defines these as follows:
IHS Diagnostic Criteria for Migraine without Aura
|International Headache Society Classification of Migraine without Aura|
|A. At least 5 attacks fulfilling Criteria B-D|
|B. Headache attacks lasting 4-72 hours|
|C. Headache has at least 2 of the following characteristics|
|â1. unilateral location|
|â2. photophobia and phonophobia|
|E. Not attributed to another disorder|
Pure menstrual migraine without auraâmeet diagnostic criteria for migraine without aura and attacks occur exclusively on day 1âÂ±â2 of menstruation in at least two out of three menstrual cycles and at no other times of the cycle.
Menstrually related migraine without auraâmeet diagnostic criteria for migraine without aura and attacks occur on day 1âÂ±â2 of menstruation in at least two out of three menstrual cycles and additionally at other times of the month
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Natural Treatment Of Menstrual Migraines
According to a Lancet review paper, menstrual migraines are more severe than migraines at other times of the cycle.
Possible drivers of menstrual migraines include estrogen withdrawal at the end of the cycle plus an estrogen-dependent release of prostaglandins and histamine. Body-identical progesterone may help to shelter the brain from estrogen withdrawal and reduce the frequency and intensity of menstrual migraines.
Treating Hormonally Mediated Migraines Naturally
Some women find relief by taking a hormonal contraceptive or hormone replacement therapy, but there are certain risks that come with each of these treatments. Here are some ways to treat hormonal migraines naturally:
- Botanical medicine Vitex agnus-castus, Tanacetum parthenium, Petasites, Zingiber officinalis
- Supplemental nutrients Vitamin B6, B2, B1, magnesium, CoQ10
- Homeopathy Constitutional homeopathic medicine prescribed for your specific headache symptoms
- Nutrition Avoiding high tyramine foods, MSG, food colorings, preservatives, chocolate, wine, aged cheese, nuts and processed foods
- Lifestyle Making sure to get plenty of exercise and sleep while working on stress management
- Craniosacral therapy or acupuncture Both can help with active headaches and prevent future headaches as well
- If you suffer from hormonally mediated migraines, make an appointment with a naturopathic doctor to create a plan to treat your specific symptoms.
For more information: Uptodate.com/contents/estrogen-associated-migraine
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