menstrual migraine

5 April 2022

Migraine and Perimenopause with Dr. MacGregor

Every once in a while I like to point you to other peoples’ articles or videos on key topics. Usually I do this on Twitter or Facebook, but this article deserves a little extra attention, as does its author.

Professor Anne MacGregor is a specialist in hormonal migraine. She has 30 years of clinical experience, and continues to work at St Bartholomew’s Hospital in London (where she teaches headache medicine), also lecturing at the University of Worcester. She is author or co-author of numerous books, including Migraine: Your Questions Answered. She has many journal publications, including Menstrual and perimenopausal migraine: A narrative review.

Recently Dr. MacGregor wrote an article for The Migraine Trust which I would like to point you to. In the article, she discusses why migraine can be a specific problem during perimenopause, and also how it can be managed. The article is available here: Migraine and perimenopause. There’s a lot of information in a short read.

She also has a previous article on menstrual migraine here: Menstrual migraine

If you would like to learn more about Dr. MacGregor, read more of her publications, or contact her, you can visit her website here.

14 August 2020

Menstrual Migraine: Risk Factors?

James Discoveries & Stats 0

A recent study in Spain surveyed university students to learn more about menstrual migraine. There were some surprising results.

First of all, 45.15% of the female students surveyed reported menstrual migraine. That is a ridiculously high number – in other words, we need to do better at proper prevention and treatment.

For a quick primer on menstrual migraine, see this graphic – Do You have Menstrual Migraine?

The interesting thing about the study were the “risk factors”. Actually, some of these are simply symptoms that seem to go along with menstrual migraine. Let’s take a look:

Dysmenorrhea (pain during menstruation): Not surprising, as migraine patients do tend to be more susceptible to pain.
Menstrual irritability: A second factor that seems to increase your chances of suffering from menstrual migraine.
Menstrual dizziness: Although not talked about as much, dizziness is a very common symptom during menstruation (see this study).

There can be certain causes for each of these symptoms, so you would be wise to mention them to your doctor. There may be an underlying problem that is related to both the symptom due to your period and migraine itself.

There were some “risk factors” that you can do something about. The two mentioned in the study were:

Daily consumption of cola beverages – yes, it is raising your risk. Sorry!
Use of hormonal contraceptive methods – another risk factor you can discuss with your doctor.

These are just little bits of information from one study, but they are worth thinking about. Menstrual migraine tends to be harder to treat than many other kinds of migraine, and is less responsive to just “popping a pill” when the pain starts. So it’s important to think about your other symptoms and lifestyle in general to fight the migraine monster.

For more on the uniqueness of menstrual migraine, see 8 Reasons why Menstrual Migraine is “different”.

For the study abstract, just go to: Menstrual migraine among Spanish university students

2 June 2016

Can Eating Chocolate Cause Headaches?

James Information 3

Short answer? Maybe. In some people. But it’s probably not a common trigger.

The question – can eating chocolate cause headaches – needs to be asked more, and investigated more seriously. Instead, chocolate has been listed regularly as a major migraine trigger, without anyone taking time to investigate the evidence.

Of course we’re actually talking about “triggers” here. The “cause” of headache conditions is a totally different topic.

It’s not easy to study the affect of chocolate on people prone to headaches, but in 1997 a study was attempted using carob as a alternative to chocolate. The result? Neither one seemed more likely to provoke a headache. (See A double-blind provocative study of chocolate as a trigger of headache.)

A study of the links between chocolate and migraine in the paper Chocolate and migraine: the history of an ambiguous association, published in 2014, suggested that we avoid calling chocolate a migraine trigger altogether.

Even in those studies reporting a more convincing association, the risk of migraine after chocolate ingestion was found to be 2- to 3-fold lower than that reported for exposure to other conventional triggers such as stress, fasting, lack of sleep and alcohol beverages. The results of the double-blind studies are instead unequivocal, and clearly demonstrate that the risk of developing a headache attack after ingestion of chocolate is as likely as administering placebo in patients with migraine. It can hence be concluded that the widespread belief that chocolate and cocoa-containing foods should be absolutely avoided by migraine patients lacks of a reliable scientific basis.
emphasis mine

In other words, there is as much change of developing migraine after taking a placebo as there is after taking chocolate.

But – “everyone” says that eating chocolate can cause headaches!

Actually, not everyone does, but more on that in a moment.

If you ask many headache sufferers – can eating chocolate cause headaches? – they will say – of course! It has happened to me more than once.

And I’m not about to suggest that eating chocolate can never trigger an attack in anyone ever.

But neurologist and headache specialist Dr. Noah Rosen points out another common connection:

Chocolate may be getting a bad rap as a migraine trigger. Many people with migraines have increased appetite and food cravings just before their headaches start.

To make things more interesting, many women with menstrual migraine experience chocolate cravings during the perimenstrual days of the month. Since the monthly cycle can also be connected to migraine attacks, the craving often comes before an attack.

Some people also associate the danger with the high amounts of caffeine in chocolate. Actually, there is an odd debate out there about just how much caffeine chocolate has. But ordinary chocolate actually has – at most – not much caffeine. If you take a huge bar and gobble it down all at once – well, even then you’re not getting huge amounts of caffeine. And you need to savour and eat more slowly anyway. 🙂

A recent report from the migraine-fighting app, Curelator, suggested that chocolate protected people from migraine as much as it triggered it – in either case, rarely.

(This isn’t the first time that researchers have suggested that chocolate may be a migraine-fighter.)

So – should I eat chocolate?

First of all, remember that moderation is very important for someone prone to headaches. Drastic, sudden changes in sleep, schedule, and diet can indeed trigger an attack. Spike in sugar are a real danger.

Can chocolate cause headaches? Well, assuming you’re eating chocolate in moderation, and eating quality chocolate without a lot of other ingredients that may be a danger to you – for most people chocolate probably won’t bring on an attack.

In fact, a small amount of quality dark chocolate once in a while is probably good for you.

A Message to Youth with Migraine

James Information, Resources, Tips 1

You just heard it from the doctor – migraine. I’m sure you’ve heard the word before – it conjures up images of headache, throwing up, missing school. But just what is migraine, and where do you go from here?

Teen headache When you unwillingly entered the world of “migraine”, you entered a world of cutting-edge medicine, history, politics, scams, misunderstanding and community. We know that migraine as a disease has existed since earliest recorded history. It’s a massive problem in the modern world – considered by many to be one of the top 10 disabling conditions globally. So it’s a real condition, and a very big deal socially, financially – and personally!

I’ve been there. Diagnosed as a teen (although I probably had symptoms long before I was diagnosed). Trying many treatments that didn’t work. Literally writhing on the floor in pain. Well, you don’t want to hear the gory details!

Here are some of the things that you need to know now in order to navigate the world of migraine.

Learn the basic vocabulary. There is no cure for migraine, and no one is sure of the cause. We know a lot about the migraine chain-reaction, a lot more than we knew when your parents were your age. However, experts still disagree about underlying cause. You’ll need to know the word “trigger” – something that sets off the migraine chain-reaction. For example, for some people, if they eat a banana, this will “trigger” a migraine attack. The banana doesn’t cause the attack, but it sets it off if you’re predisposed. It’s preferable to say that someone has migraine (the disease), and sometimes has migraine attacks.
This is not something to “just live with”. Although it is common to have migraine, it’s not something that is “normal” and that you should just settle down and live with. You should not be getting headaches, and you should get help and find good treatment. Migraine can take a lot of time out of your life, and it may even lead to permanent damage. Don’t panic – but don’t give up either. Early treatment can mean a huge improvement in quality of life down the road.
Why now? It is very common to be diagnosed with migraine for the first time in your teens. Naturally, there is a connection with development and hormones in both males and females – but particularly in young women. This can be a blessing in disguise, and can help you narrow down what is triggering your attacks. More on that below.
Diagnosis can be tricky. Chances are that your doctor did diagnose you correctly. The most likely challenge is learning what type of migraine you have, and what treatment will be most effective. Don’t assume that the diagnosis of “migraine” is final.
Everyone is different. Our bodies are very complex. Just because your Mom or best friend has migraine, doesn’t mean your symptoms will be the same. Attacks may be severe or mild, frequent or rare, regular or unpredictable. Symptoms can vary widely – some people with migraine don’t even get headaches, but experience visual auras. Some throw up, some can’t stand light or the slightest noise.
Treatment takes time. Migraine is in the category of neurological disorders (such as epilepsy). Many preventative drugs and other treatments need to be tried for 3 months before you can tell if they’re working.
You need to prioritize. There are so many treatments for migraine today that you could never try them all. However, there are some that work for many people, some that only work for a few, some that may not work for you because of your personal make up and medical history. Your doctor will help you try the treatments that are most likely to work for you, so that you won’t waste time and money (and discomfort!) on the many treatments (and sometimes scams) that you will see online.
Take notes. Doctors and specialists rely heavily on information about your symptoms in order to help you. They need to know how often you have an attack – how long – where is the pain (if there is pain) – what the symptoms are. Find a way to keep a “migraine diary” that works for you. For a flexible method using paper, try A Migraine Diary: The Lazy Way. Many apps are also available, but be sure they allow you to include all relevant information. Also, if you notice a significant change in symptoms, tell your doctor right away.
For the women: If the attacks are somehow related your monthly cycle, there are treatment approaches that may work better for you. There are two common types of menstrual migraine. For more on the challenges of treating migraine related to your cycle, see 8 Reasons why Menstrual Migraine is “different”
It’s not “stress”. I hate to add this to the list, but it is still far too common for even doctors to say that you’re “just stressed”. You know, you have all those exams coming up – that must be it. Well, that’s not it. Lots of people have been under huge amounts of stress and have never had a headache. Do not let the “stress” diagnosis keep you from proper diagnosis and treatment.

Treatments

As I mentioned above, there is a long and sometimes confusing list of possible treatments for migraine. Your doctor will help you decide if you need abortive treatment (something to do/take when a migraine attack hits) and possibly a preventative treatment (something to do/take on a regular basis) (see How many headaches are too many in a week?).

Your doctor may recommend lifestyle changes, such as avoiding certain foods, or getting on an exercise schedule that works for you.

Youth migraine Some of the best treatments that your doctor may recommend first include: magnesium, triptan type medications (such as sumatriptan), and biofeedback. Beta blockers and antiseizure medication (the same meds used for epilepsy) are also common.

Keep an open mind and take the time to try what your doctor suggests. However, if you feel your doctor doesn’t understand or is not listening to you, or doesn’t really understand migraine treatment, it’s time to go to someone else. A neurologist who specializes in migraine treatment is the way to go if possible.

Finally…

I hope that you will get rid of these symptoms soon – and there is a lot of reason to hope. You’re probably not going to die from these symptoms, and you probably will find good treatment options soon.

Yes, the road has been long for many people. But we know a lot more than we did 20 years ago. And there are many, many people who are looking for answers with you – advocates and researchers like myself, doctors and specialists (many of whom have migraine too), and scientists who are working on the cutting-edge. You are not alone.

Although migraine sufferers are still sometimes stigmatized, that is happening less, as good information gets out there and good research is being done. You can be a part of the fight against migraine, the fight for positive research and treatment.

If you know a teen who has been newly diagnosed with migraine, feel free to share this article.

15 August 2014

Using Migraine as an Excuse

James News 7

If you’re like me, you may have experienced a migraine attack that left you unable to stand, unable to drink water without throwing up – an attack that has left you writhing on the floor. If you are half as sick as this, there’s little doubt that a migraine attack is a VERY good reason to not go to work.

But today we’re not talking about someone with migraine, but someone who doesn’t have migraine at all – but they still use the “I have a migraine” excuse.

The reality is that most of the migraine patients I know will push themselves to go to work if they can, to go to that family picnic even though they’re not feeling well, to do some housework even if they have to stop and lie down every few minutes.

So although there may be migraineurs out there who “use” the condition to regularly skip work when they could reasonably go, I haven’t come across any.

So would someone without a migraine attack actually use it as an excuse? Sadly, it happens.

In fact, Troy Patterson, freelance writer and regular writer for Slate.com and Spin Magazine actually recommends the “migraine excuse” to avoid embarrassing conversations. A woman asks,“When experiencing extreme, debilitating cramps or other symptoms from menses, is it better to make up a white lie or speak the truth as to why I need to work from home?”

Mr. Patterson’s answer includes this advice:

If I were you, however, I’d avoid the subject. Who benefits by bringing it up? How does it harm anyone to shade over the truth here? I think it’s OK to shroud the red tent with a white lie.

If you donâ€™t get severe cramps every month, then you might try piggybacking on whatever bug has recently gone around the office. Otherwise, I suggest, at the risk of overkill, concocting a migraine headache. Migraines can last for hours or for days; they’re famously disruptive to work schedules and social calendars. Also, it seems somehow permissible to use a migraine as an excuse becauseâ€”well, I hear they’re awful, butâ€”they’re not contagious and they don’t generally snowball into anything fatal, right? There’s no special worry about the mortality of the migraineur. Further, some back-on-the-envelope cultural analysis suggests some mystery and glamour to the ailment. It’s a serious person’s malady, with a Didion tinge of thoughtful drama.

Mr. Patterson isn’t the only one to recommend “concocting a migraine headache” to avoid embarrassment. It’s been recommended as a way to keep your boyfriend from visiting, an excuse for avoiding sex (the classic), and a sneaky way to get drugs from your doctor to get high.

I shouldn’t have to tell you that faking a migraine hurts everyone who is really experiencing debilitating migraine attacks. But then again, maybe I do.

There are a number of things in Mr. Patterson’s answer that concern me…

Is this kind of lying morally right in the first place? Mr. Patterson seems to think so.
“they don’t generally snowball into anything fatal” – thankfully, they usually don’t, but they sometimes do. Migraine has been related to heart disease, stroke, depression, and suicide. For more, read Are Migraines Dangerous?
“Mystery and glamour”? On the one hand, I would be happy if that was the case. The reality is, there’s still a lot of stigma when it comes to migraine. Check out Those with Migraine still Stigmatized
“It’s a serious person’s malady, with a Didion tinge of thoughtful drama.” Joan Didion is an American author and journalist who wrote an essay entitled “In Bed”, vividly describing her experiences with migraine. She also talked about the then-common belief in a “migraine personality” – “ambitious, inward, intolerant of error, rather rigidly organized, perfectionist”. But it’s impossible to pigeon-hole every migraineur as this kind of person. Unfortunately, the idea that obsessive people tend to get migraine has added to the stigma more than to the science.

Perhaps we need to answer Mr. Patterson’s question – “How does it harm anyone to shade over the truth here?”

Saying you have a migraine headache when you don’t is very harmful, not only to the person lying but to migraine patients around the world. Why?

When some people lie, those telling the truth are more likely to be doubted and not taken seriously. When someone has a horribly painful debilitating migraine attack, do they really need the added pressure of having to “convince” someone that it’s real?
It cheapens the reality of migraine, which is actually quite serious and can lead to all kinds of physical problems, not to mention the emotional and social impact.
It promotes the impression that migraine is something just to be “lived with”, when in reality migraine patients need to be getting proper treatment.
Instead of adding “glamour” and “mystery” to the concept of migraine, it adds to the stigma, which means that patients are not getting the help and treatment they need.
It has the potential to erode trust between employer and employee, or between any two people when one person is not being truthful.

Not to mention that the idea of “thoughtful drama” minimizes the destruction that migraine can wreak on a person’s life. Not to mention the seriousness of menstrual migraine.

And we haven’t talked about the legal issues related to getting prescription migraine drugs on a pretense. First, a trained doctor does have good tools to diagnose you beyond just “taking your word for it”. Second, even if someone did get away with it, all this leads to is unnecessary restrictions on drugs. Migraine patients may not be able to get the treatment they need when they need it, because doctors are being over-cautious that they’re coming in for a drug-fix.

We don’t want to be insensitive to women who struggle with whether or not to share about personal health issues in situations like this. Many places have laws that protect women from having to get specific about their health issues. But there is no excuse for an employer who feels he (or even she) must push for information when it isn’t either sensitive or necessary.

But if there is that little trust between employer and employee, will lying really help?

The bottom line for our purposes. Does lying about migraine hurt anyone? You better believe it. Let’s permanently retire the “migraine” excuse for anyone who isn’t actually in the throws of a real attack. A little honesty may make a big difference for millions who are suffering with migraine.

Thanks to Kerrie Smyres for sharing Troy Patterson’s article. Don’t miss her comments in Use Migraine as an Excuse, Recommends Advice Columnist You can comment on Mr. Patterson’s article by clicking the comment icon at the top or bottom.