menstrually related migraine

12 December 2018

Your Questions: Hormone Changes before/during/after Menstrual Period

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.

woman writing — 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!

6 October 2014

Standard Blood Tests for Migraine – are they on the way?

James Discoveries & Stats, Information 0

A blood test for migraine? Today there are no standard blood tests for migraine. But is research bringing us closer?

Last month, Northwestern University in the United States announced that they had developed the “First Blood Test to Diagnose Depression in Adults“. The test uses nine RNA (ribonucleic acid) markers in the blood to “see” the difference between a depressed patient and a non-depressed patient.

A couple of years ago, researcher Eva Redei, co-lead author of the study, also developed a test to “see” depression in teens using a blood test. The markers are different in the two age groups.

This same method is being studied in for migraine disease as well.

RNA is closely related to DNA. In fact, both can carry genetic information. To perhaps over-simplify, DNA is like a library of genetic information, which RNA is like a librarian, a messenger that transmits genetic information.

Researchers have used RNA to find genetic information related to migraine, although this approach is not always successful.

A study in 2012 compared 56 adolescents with menstrual-related migraine and non-menstrual-related migraine (Genomic expression patterns in menstrual-related migraine in adolescents.). In this case, there was a significant difference between the two. Although there were commonalities, the “gene expressions” of both were quite different.

Of course in that case, asking questions and keeping a migraine diary would have probably done an even better job of diagnosing than the blood test. So will a blood test ever be useful for migraine patients?

These studies do have a tremendous potential to help us better understand various types of migraine. What is the genetic basis? Are genetic messages being interrupted somehow? Answers to these questions may lead to better treatments for specific types of migraine.

Differentiating between types of migraine and headache disorders may prove to be the biggest bonus of migraine blood tests. If we have enough information to better differentiate, we will be able to get customized treatment to a patient faster.

Although blood tests may not be useful in most individual cases yet, this research has the potential to greatly improve future treatment.

One more interesting note. One of the most successful migraine treatments also has a close relationship with DNA and RNA: Magnesium. Magnesium is involved in the transfer of information from one to the other in a variety of ways. Might this relationship explain why magnesium has helped so many migraine patients?

Do You have Menstrual Migraine?

James Information 2

For more information:

5 July 2011

Migraine and Women. Why?

James Discoveries & Stats 1

It’s a fact. More women have migraine than men. And many women have menstrual migraine, or menstrually related migraine, which is clearly influenced by hormonal cycles.

Why me??

But don’t jump to conclusions too quickly. Is migraine just a matter of hormones out of control? Are hormones the reason why there are more female migraineurs than men?

Last week we were talking about the new genetic links that have been found related to migraine. One side note on the research was that one of the genetic variations was more closely related to women than men.

This isn’t the first time that research has suggested that migraine in women may not be all about hormones. Back in 2007 you heard about research into the cortical spreading depression (a part of the migraine chain reaction) that hinted that migraine in women may not just be a result of hormones.

At this point a lot of the research is just that – hints. But in a way, it does make sense. Some women have migraine attacks closely related to their cycle – others don’t. Some women have more/less/the same number of migraine attacks during menopause/after menopause or before/during/after pregnancy. Why?

No, it’s not just hormones. Something else is going on. Maybe something genetic?

25 October 2010

8 Reasons why Menstrual Migraine is “different”

James Information, Medications, Treatments 4

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:

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)
Menstrual migraine responds better to certain treatments. More on that below.
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)
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)
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)
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)
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)
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).