Did you know that 7 in 10 people with migraine are women? And that women tend to experience migraine days three times more frequently than men. Among these women with migraine, about 70% report that the frequency and intensity of their migraines are connected with their monthly menstrual period. This finding is not surprising given the intricate relationship between the body’s endocrine (hormonal) and nervous systems.
Researchers have noted that hormonal fluctuations can bring about menstrual (period) migraine. This tendency toward migraine begins to emerge for many girls around the same time as puberty, marked by a surge in the female hormone estrogen.
Studies show that migraine days can occur a few days before, during, or immediately after a woman’s period and or/during ovulation. Symptoms typically resemble migraine without aura — temporary visual or other sensory disturbances that might precede and/or accompany a migraine intrusion — although some girls and women may experience aura as well. Uncomfortable menstrual migraine symptoms can include one-sided throbbing headache, nausea, hypersensitivity to sounds and bright lights, pale skin, fatigue, feeling too warm or cold, and/or loss of appetite.
If you have episodes of menstrual migraine, tracking your menstrual cycle and keeping a headache journal can help you effectively communicate your experience to your healthcare provider. Because hormonal fluctuations cause these types of headaches, and because different medications may potentially have certain side effects, turn to your physician to get an informed diagnosis of your menstrual migraines and help in finding relief.
Let’s look at some typical treatment strategies, as well as some behavioral modifications that may help as you and your doctor narrow down your optimal treatment plan.
Acute Treatment of Menstrual Migraine
Medications shown to be effective for the acute treatment of menstrual migraine (taken as needed once the episode has begun) include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
- Dihydroergotamine (DHE), injectable or nasal prescription medication used to relieve migraine episodes
- Triptans, a class of migraine medications including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
- A combination of NSAIDs (such as naproxen), acetaminophen (also referred to as common brand names Tylenol and Panadol), and caffeine (although excessive intake might actually induce a migraine)
These medications may also prove useful for short-term prevention, if started a few days before menses begins.
In addition, a 500mg dose of magnesium twice a day (specifically, magnesium oxide for migraine treatment) can be an effective treatment for migraine and cluster headaches. Generally safe, magnesium can cause abdominal cramping and diarrhea, and dosage should be lowered in this case. And because magnesium can also lower blood pressure, your doctor will determine if regular magnesium supplements are a good option for you.
If these options prove ineffective or need to be used too frequently, it might be time to consider some of these preventive treatment options.
Every girl and woman is unique and, because migraine disorder can be a chronic condition, it may be necessary to modify or change optimal treatment strategies over time, as your body changes. For example, if you’re a woman with migraine and want to start hormone replacement therapy to help transition smoothly into menopause, your doctor may prescribe an option with a lower dose of estrogen or have you adopt a more continuous regimen that lessens the effects from shifting hormones.
Preventive treatment options for menstrual migraine include:
- Antidepressants, including tricyclic antidepressants (TCAs) like amitriptyline (Elavil) or nortriptyline (Aventyl, Pamelor). Use of TCAs calls for extra caution, as antidepressants can come with side effects and are contraindicated for pregnant women and people with heart disease. Other classes of antidepressants, such as selective serotonin and norepinephrine reuptake inhibitors (SNRIs), may also be prescribed. Fluoxetine, an antidepressant commonly used to treat premenstrual dysphoric disorder (PMDD) symptoms, may also relieve pain during the menstrual cycle.
- Beta blockers such as atenolol (Tenormin) or metoprolol (Lopressor), commonly used to control blood pressure as they work to relax blood vessels. However, they can also contribute to low mood and sexual problems.
- Anticonvulsants such as topiramate or valproic acid (also commonly used to prevent epileptic seizures). Drowsiness and lack of focus are common side effects. Your doctor will take care in prescribing these, as anticonvulsants may alter the efficacy of oral contraceptives and other hormonal therapies.
- CGRP (calcitonin gene-related peptide) inhibitors, a new class of preventive drugs such as Atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Learn more about CGRP inhibitors.
- Hormonal therapies/hormone replacement therapies: These therapies are some of the more prevalent approaches to help manage menstrual migraine. Estrogen and progesterone levels spike mid-cycle and drop just before menses begins. Addressing these hormonal shifts — and perhaps reducing the number of menstrual cycles for a time — have proven effective in preventing menstrual migraine days. This approach can be managed via estrogen supplementation (in a patch, as a gel, or as pills). Women with migraine who already use a traditional oral contraceptive with estrogen and progesterone might benefit from taking it daily for their entire cycle, rather than following the typical 21-day approach; a doctor will recommend if this method makes sense and how long it should be followed.
At Mable, we believe passionately that a multi-dimensional approach — an informed combination of lifestyle modifications and pharmacological interventions, tailored to you — can be the best approach to treating your migraine episodes.
Some key recommendations:
- Sleep well. Sleep quality fluctuates throughout the menstrual cycle, particularly in women with migraine. Prioritize a good night’s sleep, and create a migraine-friendly sleep environment for yourself, including a dark, cool room with minimal exposure to blue light.
- Avoid salty foods close to your period. You’re more vulnerable to a migraine close to your period, as water retention and inflammation increase in the body. At this time, steer clear of salty foods that may encourage water retention.
- Don’t skip meals. During your cycle, cravings are normal and, conversely, so is loss of appetite. A woman’s body passes through several changes during her monthly cycle, and nutritional needs adapt accordingly. Skipping meals may encourage a drop in blood pressure and allow the onset of migraine, so take care to maintain a regular meal routine.
Check out the Mable blog for effective yet simple lifestyle modifications and home remedies, as well as an overview of the latest migraine medications.
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