8 Reasons why Menstrual Migraine is “different”

Menstrual migraine (including menstrually related migraine, true menstrual migraine, etc, and sometimes called a period headache) certainly isn’t the only type of migraine out there.  But it is a common type.  And it is… well, different!

Until recently, menstrual migraine often wasn’t distinguished in diagnosis and research from other types of migraine.  But now we’re starting to study it as something unique, and because of that we’re learning more about it than ever before.  Some recent studies are shedding more light on the uniqueness of menstrual migraine.  For example, did you know:

1. Menstrual migraine attacks tend to last longer than other migraine attacks.  A recent study suggests that they last more than 30% longer, on average, than other migraine attacks. (Pinkerman and Holroyd 2010)
2. Menstrual migraine responds better to certain treatments.  More on that below.
3. Menstrual migraine doesn’t respond as well to short term treatment, such as abortive drugs.  Often preventative treatment is the answer (menstrually related migraine may happen at various times of the month, in an unpredictable pattern). (Pinkerman and Holroyd 2010)
4. Menstrual migraine is more likely to be disabling.  Of course, other types of migraine may disable more, but on average menstrual migraine seems to often be worse than average. (Pinkerman and Holroyd 2010)
5. Menstrual migraine is more likely to return.  A recent study demonstrated that the pain was far more likely to come back after four hours being pain-free. (Pinkerman and Holroyd 2010)
6. Menstrual migraine may have distinct biological differences, beyond "hormones".  Recent research is looking into the various factors that may cause menstrually related migraine, including genetics. (Colson et al 2010, Aurora 2008 in Menstrual Migraine)
7. Monthly attacks are more likely to be migraine without aura or tension type headache.  Migraine with aura is less likely to be linked to your period. (Stewart et al. 2000)
8. Menstrually related migraine affects up to 60% of female migraineurs (Lay and Payne 2007)

Treatment!

Menstrual migraine may be severe and hard to treat, but it has been treated successfully in many, many women.  However, doctors are realizing more and more how important it is to get a proper diagnosis, and to treat menstrual migraine specifically, not just the same way any type of migraine is treated.

Although this type of migraine may not respond as well to short term treatments, some women find that an abortive drug is all they need.  Usually this is a triptan (commonly sumatriptan, rizatriptan or frovatriptan), and/or NSAIDs such as mefenamic acid or naproxen.  Sometimes something is given for the nausea as well.  Dihydroergotamine (DHE) is also an option.

If one triptan doesn’t work, try another.  There are several others that have helped many with menstrual migraine.

On the preventative front, one common approach is hormone therapy.  Magnesium therapy also seems to be particularly effective for menstrual migraine.  There is some evidence that vitamin E may help with some symptoms.

Preventative medication may also be tried.  Typical migraine preventatives have met with some success, such as verapamil (a calcium channel blocker), topiramate (particularly for patients who don’t take oral contraceptives) and valproate, propranolol (a beta blocker), and fluoxetine (an anti-depressant).

For more, check out Menstrually Related Migraine from the National Headache Foundation, Menstrual and nonmenstrual migraines differ in women with menstrually-related migraine. (study from 2010), Prevention and treatment of menstrual migraine. (study from 2010), and Menstrual Migraine (2008).