Health Column
July 2009
MEDIA CONTACT: Joyce Brennan
Public Information Officer
Southcoast Health System
Phone: 508-961-5270
Fax: 508-961-5876
Pager: 508-387-9605
brennanj@southcoast.org
www.southcoast.org/news/releases/
Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women, Inc., New Bedford and Mattapoisett
Dr. Pope practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals
Group. He can be reached at 508-999-6245
Menstrual Migraines: Really?
Migraine headaches can affect your quality of life and in some case become debilitating.
Women in particular have a higher rate of migraines, approximately 18 percent of women
as compared to 6 percent of men. Women in their reproductive years are the most
severely impacted group of migraine sufferers and are not often aware of the connection.
There are number of factors, treatments and preventative methods that should be
considered before you can determine the cause and treatment for you.
What is a migraine attack?
Migraine attacks present as a complex constellation of symptoms of which headache is
the most prevalent. In women, initiation of migraine attacks is often linked to the
hormonal milieu associated with one’s menstrual cycle. Therefore, migraines often wax
and wane throughout a women’s reproductive life in response to hormonal events. More
than half of women with migraines report an association between migraine and
menstruation, and these attacks are described as more debilitating than migraines
occurring at other times. More importantly, they are very real.
Migraine headaches and the menstrual cycle.
In general, the migraine headache results from both alterations and widening of blood
vessels within the brain that effect surrounding nerves and sensory nervous pain
pathways. It certainly is a complex neurobiological event involving a person’s neurologic
system and blood flow in the brain. Unfortunately, it is still not completely understood.
What is the “trigger”?
There is a genetic predisposition to having migraines, in which those with family
histories may have a lower threshold for sensory activation than those without a family
history of migraine headaches. Multiple risk factors or “triggers” are also associated with
migraine attacks: alcohol consumption, excessive stress, dietary changes, change in
sleeping patterns, and hormonal change due to menstruation.
Menstrual migraines affect 12 million women and are defined as occurring two days
before and/or three days after the start of menstruation. Migraines associated with
menstruation do not occur at any other time during the menstrual cycle, and women must
experience attacks in two out of three cycles. Symptoms are described as a one-sided
headache, pulsating quality,moderate to severe intensity and aggravation with physical
activity. In addition, sufferers may experience nausea, but usually not light and sound
sensitivity.
Why do I have wacked out hormones?
There is a diminished secretion of ovarian hormones during the premenstrual phase,
including a decline in progesterone and estrogen levels. It is thought that the consistent
ebb and flow in the hormonal milieu during the reproductive cycle functions as a trigger
in provoking migraines. Studies have shown that an abrupt drop in estrogen levels
following a period of sustained high levels with trigger migraines. This drop occurs right
before menses begins. Other hormonal changes associated with the menstrual cycle are
increases in prostaglandin levels, magnesium deficiency, and drops in serotonin levels.
What? Wacked out hormones? No, just kidding, this is considered a normal fluctuation in
hormone levels.
Does anything help?
There is no standard quick fix. It depends on the patient. Treatment should be tailored to
the individual woman’s needs and severity. A combination of patient education and
behavior modification with pharmacologic therapies usually works well. Many women
try non-medical treatment to manage their migraines before they begin drug therapy.
Such therapies include behavior modifications such as relaxation strategies and training,
as well as physical therapies like acupuncture, yoga, osteopathic cranio-sacral
manipulation, massage, Rolfing, and increased in regular exercise. Quitting smoking and
not consuming excessive alcohol are also recommended.
Keep a headache diary.
A headache diary can be an excellent and effective tool in tracking symptoms, severity
and frequency of migraine attacks. Triggers can usually be found based on analysis of the
headache diaries and should be avoided as much as possible. Make sure you share this
diary with your physician.
What medications work?
There are two ways to treat migraine headaches: acute therapy, of which there are classes
of medications to abolish a headache right away; and preventive therapy, of which there
are several options.
The three classes of medications that treat a menstrual migraine effectively are nonsteroidal anti-inflammatory drugs (NSAIDS), Triptans, and Ergots. As a general
guideline, if at least 80 percent relief from headache pain is not achieved after taking pain
relievers such as ibuprofen, acetaminophen or Advil, for a period of 4-6 hours, or if
treatment needs to be used continuously for more than two days, you should contact your
physician as prescription treatment may be suggested.
A quick note, taking pain relievers for an extended period of time can lead to other
serious side effects such as liver damage and stomach ulcers, therefore their use should
not be long-term.
Naproxen sodium is the first line NSAID treatment for the treatment of migraine and
usually does the trick.
Preventative medications
Preventative medications used include b-blockers, calcium channel blockers, tricyclic
antidepressants, anticonvulsants, NSAIDS, hormonal therapy (hormonal and oral
contraceptives, estrogen topical patches and gels) and rarely GnRH agonists. Short-term
prevention is effective in women with predictable menstrual cycles. Perimenstrual
treatment such as Naproxen or Frovatriptan with monthly regimens can work. Estrogen
treatment has also proven to be effective to try to prevent the sudden drop in estrogen
levels that accompanies the onset of menses and the prevailing headache. All such
medications carry potential risks that must be considered and the benefits of alternative
therapies should be reviewed together with your physician prior to starting treatment.
Treatment can help restore your quality of life
Migraine is a common, complex and bewildering malady, affecting nearly 28 million
Americans and often associated with substantial disability. Menstruation often is a
significant trigger of migraine in women and causes major disruption in women’s quality
of life. Multiple treatment options are now available for both acute and prevention of
migraine that help restore the function and quality of life in women with menstrual
migraine. Menstrual migraines, yes really.
# # #