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.
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.
Thanks to Adrie from South Africa for this question about migraine attacks around the time of her menstrual period (ask your own question here!).
First, a quick definition, because it is important for treatment. There are two classes of migraine here. One is menstrually-related migraine. This is when attacks occur at least 2/3 of the time day -2 to +3 of your menstruation, but attacks also occur other times of the month.
Keeping track of daily activities and symptoms is very important in menstrual migraine.For the purpose of this question, however, we’ll focus on pure menstrual migraine, in which attacks occur 2/3 of the time day -2 to +3 of your cycle, but at no other time. (Here’s a summary of menstrual migraine in graphic form.)
There is no doubt that hormones are related to these attacks – but, surprisingly, just how they’re related is a bit of a mystery. The theory that we should simply be able to adjust hormone levels to solve the problem has not been the silver bullet.
Adrie is actually already a ways down the road searching for treatment, but hopefully we can help her or some other reader consider some options that haven’t been investigated fully. And remember, we’re speaking more generally anyway, because we will not diagnose a specific case here (even if we had enough information, which we don’t).
But first, the “treatment” that should not be tried – hysterectomy. Dr. Robert Cowan explains well in his book The Keeler Migraine Method:
In the past, doctors tried to modify this trigger through hysterectomy but today we know that hysterectomy will not improve migraines and can in fact make them significantly worse. Hysterectomy causes chaos in estrogen levels, estrogen receptors, and the chemicals that estrogen modifies. A migraineur’s brain does not like chaos. It likes things nice and regular and predictable.
So what are better options? Here are a few:
All-month Lifestyle: If certain things make your attacks worse, don’t fall into the trap of being careful only when the symptoms start. Even something you do days before can impact your symptoms. Are you eating properly? Getting enough sleep? A healthy diet and balanced lifestyle overall can improve things significantly.
Drug options: Taking an abortive even before the attack hits, or early on, can help you avoid the migraine monster. NSAIDs are commonly prescribed. One of the most helpful targeted migraine drugs is frovatriptan, taken twice a day for five days starting two days before you expect your menstrual cycle to begin. Here’s a quick summary of other medications.
Hormone Replacement Therapy: If I understood correctly, this is something Adrie is trying, but so far without success. This has helped many women, but again, it’s not the solution for everyone.
Contraceptive Changes: If you’re using a contraceptive that’s affecting your hormones, there are a number of options you could try, either to help narrow down what’s causing the problem, or to alleviate symptoms. For example, trying a low-estrogen pill, or investigating other forms of contraception.
Hydration: Dr. Angela Stanton, the “Queen of Hydration” thanks to her book Fighting the Migraine Epidemic, discusses in detail systems of hydration for migraineurs. Jumping of current research into the reason for menstrual migraine, she suggests that the female brain needs more “voltage” to run the menstrual cycle. Her suggestion (along with her full system that you can read about in the book) is to prepare 5 days ahead – no sugar, and more water (along with more salt). In her system, that would be an extra glass of water and an extra salt pill a day.
Preventative Medications: Preventative meds should be used cautiously with pure menstrual migraine, because they will affect your body 24-7, not just once a month. However, in severe cases, doctors may suggest a preventative.
Supplements: Adrie has tried some supplements without success. But some of the top ones include magnesium (and if one doesn’t work, try another – see Which Magnesium Supplements Work?) and vitamin E.
Other Treatments: If drugs can be avoided, or fewer drugs taken, that’s a better road to travel. Some excellent treatments include biofeedback, massage, deep breathing, and essential oils.
Final note: Keep a diary. Keeping track of your attacks is extremely important with menstrual migraine, even though you would think it isn’t. Some women find that, for example, when they give into a premenstrual craving, they make symptoms worse. Dr. Cowan, mentioned above, gives one story of a patient that illustrates well the need to keep track:
Partial triggers may show up in association with other triggers. For example, I had a patient who got her most severe headaches when she had her nails done during her period but not at other times. It took her about four months of journaling to pick this up. When she changed salons to a place that didn’t use heavy lacquers, she was fine.
Menstrual migraine is a difficult beast to fight (see 8 Reasons why Menstrual Migraine is “different”). But there are good solutions out there. Feel free to leave a comment, letting us know what has worked well for you!
The link between migraine and stroke is nothing new, but recent research is making it a hot topic once again. In particular, there are increased concerns about the risk of stroke in women with migraine.
A study in Turkey (Istanbul University) focused on patients with their first stroke, between the ages of 15 and 50, compared to gender and age matched healthy patients. Frequency of migraine was almost double in the stroke patients. But when different types of migraine were compared, the results were much more specific. The only ones with an increased risk were women with migraine with aura. Another study in the American Journal of Obstetrics and Gynecology suggested that women with migraine with aura who also used hormonal contraceptives were at a significantly higher risk.
Another study out of Harvard University and Massachusetts General Hospital in Boston focused on those who experienced stroke after surgery – again, patients with migraine – especially migraine with aura – were at an increased risk in the first 30 days after surgery. (Migraines tied to increased stroke risk after surgery)
Each of these studies has its strengths and weaknesses, but the research continues to suggest that people with migraine, especially women with migraine with aura, have an increased risk of stroke.
It’s important to remember that this is not a high risk, in the sense that you’re just guaranteed to have a stroke. If you have migraine, chances are you won’t have a stroke any time soon. But, like smoking or a poor diet, migraine does increase your risk. It increases your chances.
So its all the more important to treat your migraine, and minimize other risk factors that you can control.
Finding good treatment for migraine may do more than just alleviate pain – it may decrease your risk of stroke. And some migraine-fighters, such as magnesium, may also fight stroke.
For example, a study published last month in the American Journal of Medicine researched data on women who were evaluated for ischemic heart disease (“hardening of the arteries”). Of those women, anyone who had reported a history of migraine was at a higher risk of a “cardiovascular event” such as stroke or heart failure. (Study abstract: