Regular Exercise Can Help Prevent Menstrual Migraine
When we consider all the strategies to prevent migraine attacks, I love it when people choose to make lifestyle modifications that can make a real difference, says Hindiyeh.
There’s lots of evidence to suggest regular aerobic exercise can work as a preventive medication all on its own, and there are some studies to suggest that yoga and HIIT can be helpful as well, says Hindiyeh.
A review published in 2020 in Current Pain and Headache Reports identified numerous studies showing that aerobic exercise could reduce migraine frequency, intensity, and duration, with higher-intensity exercise having more benefits. But the author observed that low-impact exercises such as yoga could also have benefits.
Not only can regular exercise help prevent migraine attacks for some people, but also, if the headache is mild, a short bout of exercise can actually help relieve the headache that’s happening, according to Hindiyeh.
On the other hand, overexerting yourself can be a trigger for migraine, especially if you are already having a migraine attack, she says.
One of the cardinal definitions and features of migraine is that normal activity can make you feel worse. If you’re already in the middle of a severe migraine attack, moving around excessively is going to make things worse for you its probably not the best time to go for a jog or do some aerobic activity, says Hindiyeh.
Hows A Menstrual Migraine Diagnosed What Tests Are Done
Your healthcare provider will want to establish a history of your migraine-related symptoms, likely asking you to:
- Describe the severity and location of your pain. Is the pain pounding? Pulsing? Throbbing?
- Tell how often you get migraine headaches.
- Remember if anything makes your headache better or worse.
- Discuss what medications you take to relieve the pain and how often you take them.
- Talk about the activities, foods, stressors, or the situations that may have brought on the migraine.
- Remember if anyone in your family gets migraine headaches.
- Tell how you felt before, during and after the headache.
Your healthcare provider may also order blood tests and imaging tests to make sure there are no other causes for your headache. An electroencephalogram may be ordered to rule out seizures.
Its helpful to both you and your healthcare provider if you keep a migraine journal. Take note of what symptoms you get, how long your symptoms last, and what makes your menstrual migraine better or worse. You and your healthcare provider may be able to use that information to help you heal, and possibly prevent or anticipate your migraine.
Menstrual Cycle Headaches & Migraines
Two types of headaches most commonly occur during our menstrual cycles: tension headaches and migraines. Tension headaches typically feel as if theres a pressure band wrapped around your head, or like a pulsing in your temples or behind your eyes, and women commonly experience them before their periods start but they may not have a uniquely hormonal cause and can be due to other common headache causes that occur coincidentally around your period, particularly if your period is a stressful time for you in general.
Menstrual migraines have a well-established hormonal basis. If youre a migraine sufferer in general, unfortunately, youre more predisposed to having hormonally triggered ones, too. As many as 70 percent of women migraineurs experience a menstrual association. Dont you feel lucky! However, it is possible to only have menstrual migraines called pure menstrual migraines and not have them otherwise. Here are some the known or suspected links between our cycles and migraines.
As Estrogen Drops, Serotonin Does, Too
We Have a Lower Pain Threshold Before Our Periods
Histamine Gets Into the Act
It Can Happen Around Ovulation, Too
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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.
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?
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The 2 Triptan Medications That Work Best This Time Of Month
There is a family of migraine medications called Triptans that are effective for hormonal migraines – for those who they workfor! Science still does not know why they work for some and not forothers!
Triptans work to reduce inflammation of the blood vessels in the brain that cause the pain. They also block chemicals in the nerve endings “and they preventtransmission of pain signals from the lining of the brain to the brainitself.”
They are extremely expensive, here in Australia, but areremarkably effective. Naramig is now covered on PBS, so be sure to ask your doctor. If you have not tried them for your hormonalmigraines, then I suggest that you see your doctor and consider them.The studies are impressive and I have found that they are definitelyworth a try. Be prepared, it might be trial and error until you findone that works for you.
The recommendation from my doctor is that women can take a triptanfrom “two days before their period starts to two days after and see ifit makes a difference.” So approximately 11 days each month.
Frovatriptan and Naratriptan are the best triptans to take for treating menstrual migraines. Make sure you get your medications from somewhere reputable like a trusted local pharmacist.
Frovatriptan is most commonly used to manage hormonal migraines. You start them 2 days before you usually get a migraine and keep taking them for 6 to 7 days total.
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 medicineVitex 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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Foods That Contain Magnesium
For those who dont want to take supplements, some foods naturally contain magnesium.
Dark leafy greens like spinach and chard are some of the best foods you can eat. One cup of either contains between of the recommended daily value of magnesium.
Other foods that contain magnesium include:
- seeds, like pumpkin or squash seeds
- mackerel, tuna, and Pollock fish
- low-fat yogurt or kefir
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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Prevention Of Hormonal Headache
Prevention can include medications that reduce the likelihood of a migraine from occurring, as well as making lifestyle changes.
According to the AMF, healthcare professionals may prescribe preventative medications that are off-label. In other words, they are not specifically designed to prevent migraine, but they may help.
Common medications for prevention include:
- Hormones: These come in various forms such as oral, gels, or patches that help prevent a drop in hormone levels leading up to menstruation.
- NSAIDS: A person can take these approximately twice a day in the week leading up to menstruation.
- Magnesium supplement: A person can start taking these on the 15th day of the cycle and continue until menstruation starts.
- Triptans: A person can take these twice a day during menstruation. They may help prevent hormonal headaches from occurring.
Another option is for a person to use continuous hormone therapy, often in the form of hormonal birth control. This approach may help regulate hormone levels and prevent headaches from occurring.
Finally, a person can take steps to avoid other triggers that may contribute to their migraine. This can include:
- eating a healthy diet and avoiding foods that may trigger an attack
- regular exercise
Determining What Hormonal Contraceptive Is Right For You
Having migraine with aura is not the only deciding factor on whether and what type of hormonal contraceptive to use.
Women who are not good candidates for combined oral contraceptives include the following:
- Those over age 35
- Those who have multiple risk factors for stroke, such as high blood pressure, high cholesterol, smoking and obesity
“I think for those women, it’s an absolute no-no, and they should consider other non-estrogen contraception,” Rao says. “But if you’re young and healthy, you have lower vascular risk factors, and you truly do not have aura with your migraine, then I think it would be safe to consider it,” she adds.
No matter which way you’re leaning, however, always have the discussion with your provider first to truly determine whats appropriate for you.
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Talk To An Ob/gyn Provider
The team at Triangle Physicians for Women is here for you in all stages of your life and are committed to providing you with comprehensive care. Whether youre a new patient or a regular with us we strive to offer the highest quality of care. To make an appointment, call the office at 678-6900 or contact us online.
What Is A Menstrual Migraine
According to the International Headache Society, a pure menstrual migraine is a migraine that occurs only:
- Within the two days before your period .
- Throughout the third day of your period .
- In at least two out of three menstrual cycles monthly.
- At no other point in your cycle.
If youve noticed similar migraines that dont fit the above criteria, you may experience menstrually related migraines. Menstrually related migraines can affect women at any point outside of the -2/+3 window within their cycles.
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Treatment Options For Menstrual Migraine
There are several treatment options depending on the regularity of your menstrual cycle, whether or not you have painful or heavy periods, menopausal symptoms or if you also need contraception.
If you have regular periods your doctor may suggest taking medication for a few days around the time of menstruation .
There are different options available and your doctor should suggest the option that suits you. It could include non-steroidal anti-inflammatory drugs such as naproxen or mefenamic acid, oestrogen supplements or triptans.
- Frovatriptan tablet
- Zolmitriptan tablet
What Causes A Menstrual Migraine
As experts develop research on menstrual migraines, weve learned that they are a symptom of hormonal changes within the menstruation cycle.
Right before women experience their period, their estrogen levels drop due to a lack of fertilization. Though this is a natural aspect of menstruation, researchers have found a link between the rapid decrease in estrogen and menstrual migraine symptoms.
During menstruation, women also release more prostaglandin, a hormone that helps control ovulation. Prostaglandin levels are higher for women with painful periods and have also been linked to menstrual migraine.
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The 3 Top Alternative Remedies For Menstrual Attacks
- NSAIDS – Non-steroidal anti-inflammatory drugs. Over the counter pain relievers like ibuprofen or naproxen can help prevent menstrual migraines or make them less severe. “You typically take them twice a day starting 2 to 3 days before your period begins, and then for another 3 to 5 days after it arrives.”
- Bio-identical Estrogen Cream . Sometimes you can prevent the onset by taking a steady dose of estrogen throughout your menstrual cycle. If you’re already on birth control, you can consider switching to a continuous dose. So this means that you would take the estrogen pills during the days when you’d normally skip pills or take inactive ones. ** If you have migraine with aura, talk to your doctor before you start taking estrogen as it may raise your odds for a stroke.**
- Magnesium. Its good to keep your magnesium levels up to help prevent a menstrual migraine from occurring. Start taking magnesium on the 15th day of your cycle and keep taking it until you get your period. I’ve written more about it here – Which Magnesium Is Best For Migraines?
Is It Migraine Or A Headache
Migraine attacks are different than common headaches. They typically cause severe levels of throbbing pain and usually occur on one side of the head. Migraine is categorized as with aura or without aura.
If you have migraine with aura, you may experience one or more of the following symptoms in the 30 minutes before your attack:
- seeing flashes of light
- seeing unusual lines or spots
- a temporary loss of vision
- numbness in the hands or face
- tingling sensations in the hands or face
- changes in speech
- unusual changes in smell, taste, or touch
The symptoms of migraine with aura can also include:
- sensitivity to light or sound
- pain behind one eye or one ear
- pain in one or both temples
Common headaches are never preceded by an aura and are typically less painful than migraine.
There are different kinds of headaches, including:
- Tension headaches. High levels of stress and anxiety can cause tension headaches. They may also be caused by muscle tension or strain.
- Cluster headaches. These headaches are often mistaken for migraine. They typically cause pain on one side of the head and may include other symptoms such as watery eyes, runny nose, or nasal congestion.
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How To Take Care Of Yourself If You Get Migraines During Your Period
Ah, menstruationgiver of stained underwear, unrelenting cramps, and, for some people, migraine attacks. If you feel a vise-grip around your skull right around the time your uterus decides its time for a deep cleaning, its probably not a coincidence.
Menstruation is a very common trigger of migraine attacks in women, Addie Peretz, MD, clinical assistant professor in the department of neurology and neurological sciences at Stanford University School of Medicine, tells SELF. Migraine is a complex neurological condition that essentially makes your brain really sensitive to certain triggers, which can lead to painful attacks. For some people, migraine triggers include certain foods, a lack of sleep, or stress. For others, the drop in estrogen that occurs right before their period starts can bring on an attack, she says.
If you have menstrual migraine attacks, you already know they really suck. Migraine attacks associated with menstruation tend to last longer, be more disabling, and are less treatment-responsive than non-menstrual migraine attacks, Dr. Peretz says.
The overall goal is to decrease the intensity and the frequency of the migraine attacks so they have as little impact on your day-to-day functioning as possible. Thats a universal goal of migraine treatment, but is especially true during the menstrual cycle, Mason Dyess, DO, a neurologist and headache medicine specialist at Ochsner Medical Center in New Orleans, tells SELF.
Which Treatment Option Is Best For You
Keeping a diary of your headaches, including when they occur in relation to your menstrual cycle, as well as their severity and response to treatment, will help your doctor determine the presence of menstrual migraine. There are not any blood tests or any type of imaging that can be done to diagnose this, says Dr. David. Its purely done based on the history.
A headache and menstrual diary can also help you and your doctor identify the best treatment for you. Women with menstrual migraine who have painful cramps may benefit more from a NSAID strategy with a triptan for rescue. Those who have predictable cycles and migraine attacks may benefit from a mini-prevention strategy. Those who dont have regular cycles can try other options.
It is also important to discuss with your doctor any personal risk factors you may have for taking oral contraception, such as an increased risk of stroke, heart disease or blood clots, as hormonal birth control can affect women with migraine differently. Please let your provider know if you have migraine with aura when discussing hormonal options.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
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