Wednesday, June 21, 2017

Help For Menstrual Migraine

If you are a woman struggling with migraines, you may have noticed they tend to get worse at a certain time of the month. Most women report onset of migraines a few days before the start of their cycle, the day of, or even a few days after a menstrual cycle has begun. Others report an increase of migraine pain at the days surrounding ovulation. If you are anything like me, I used to experience the onset of a migraine about a day before my period started. This migraine would last for nearly 2 weeks, days varying in pain level, peaking again at ovulation, and then declining for about a week until the vicious cycle started all over again.

The reason this happens to women is because our hormones rage in varying levels throughout the month. Right before the start of a new cycle, hormones estrogen and progesterone rapidly drop off. The opposite being true, right before ovulation (mid-cycle) estrogen and progesterone levels rise to their highest levels and for many this brings the onset of headaches and migraines. Many other factors come into play as well, including age. When women enter perimenopause (pre-menopause) many find they start experiencing migraines and headaches for the first time. Those who were already suffering tend to find they become worse. This is due to the decline of hormones and the unpredictability of a regular cycle as we age.

Interesting to note, many women who already suffer from migraines have reported they completely stop during pregnancy. And yet others may experience migraine for the first time during pregnancy. The same goes for menopause with seemingly no consistent pattern. For some women, migraines end with menopause, begin for the first time, or don't change at all. Sigh. It's difficult to be a woman. I don't know about you, but when I was suffering from severe hormonal migraine in my mid-thirties, the idea of plowing through and attempting to survive the next 20-25 years until menopause seemed bleak and hopeless.


As with all aspects of migraine, there are a lot of opinions out there about how to treat hormonal migraines and headaches. I am going to present various options and then tell you what has worked best for me.

1. NSAIDS. If you do not suffer from chronic migraine, a good place to start is by treating the migraine and headaches during days you are most susceptible with a non-steroidal anti-inflammatory medication (NSAID) such as Aleve, Tylenol or Ibuprofen. Bonus: a daily IBUprofen also lightens the flow! Starting a few days before the start of your menstrual cycle, and taking every day until the period ends, could possibly even prevent a migraine or headache from ever occurring. The key is to start a few days before your period in order for this method to work.  I would only use this method if you mainly have headaches or migraines around the time of your menstrual cycle and not as many the rest of the month, because overuse of NSAIDS can cause Medication Overuse Headache.

2. Triptans There are certain drugs in the Triptan group which are longer lasting and therefore perfect to use during a specific time of the month. Ask your doctor for a dose of Naratriptan (Amerge), Zolmitriptan (Zomig), or Frovatriptan (Frova) to be taken during the days of your cycle when migraine hits the hardest. If your migraine starts on day 1, start the triptan one or two days before and you can continue taking this for up to 7 days. In many cases, this will completely eliminate the migraine from even occurring.

3. Supplements. It's no secret there are multiple types of supplements that help prevent migraine. If you struggle with hormonal migraines, supplements can possibly help those as well. High doses of Magnesium (up to 500 mg), Vitamin B2/Riboflavin (up to 400 mg), and C0Q10 have been proven effective in reducing pain level and frequency of migraines. There are also several herbs including butterbur and feverfew that have reportedly been effective for many. Supplements must be taken daily for 3 months before you will notice any difference. Also, please consult a doctor before taking any of these supplements and read ingredients in the supplements you choose to purchase, making sure it has the lowest amounts of additives and does not contain MSG or other possible triggers.

4. Diet. Isn't diet a key to pretty much every health ailment? Find foods that trigger migraine for you. Some of the most common are gluten, dairy, foods high in tyramine and histamine, MSG, soy, caffeine, and foods with preservatives. If you avoid trigger foods during the whole month, there is a theory it will also help reduce the frequency and pain level of hormonal migraines. I am on a very strict diet, but I can't say this has helped my menstrual migraines all that much.

5. Avoid trigger stacking. There are many factors that can trigger migraine: hormones, diet, weather, lack of or too much sleep, stress, emotional changes and medications---these are some of the top triggers. Ever wonder why sometimes a certain food might trigger a migraine and other times it doesn't? Experts attribute this to what has been termed, trigger stacking. It's the idea there are certain times of the month, or certain factors which make someone more susceptible to a migraine attack than others. If you add multiple triggers on on top of each other, you are pretty much guaranteed a nasty migraine. For example, if you are prone to getting migraines at the start of your menstrual cycle, aren't getting enough sleep, and then eat a food trigger like pizza, this is trigger stacking and you are setting yourself up for the inevitable. But if you avoid as many triggers as possible around the menstrual cycle, it can definitely lower the pain level and possibly help you avoid it entirely.

6. Birth control. Considering headaches are a common side effect of the birth control pill, it is not surprising the Pill often makes migraines and headaches worse for those already suffering. There is a very small percentage of people that will find improvement in their migraines from taking the Pill, because the Pill switches off the normal menstrual cycle, the natural fall in estrogen does not occur. The key here is to not use the placebo days to keep estrogen from bottoming out, and to take the Pill continuously for up to three cycles before taking a break. Some doctors may allow their patients to take the Pill continuously without ever taking placebo pills.

7. Bio-identical hormones. This is an all natural type of hormone preparation made at a compounding pharmacy which can be tailored to the specific dose your body needs. There is a theory that women with menstrual migraine are most likely "estrogen dominant" meaning the ratio of estrogen to progesterone sways one way or the other, causing imbalance of hormones. Often women will find complete elimination or major reduction in menstrual migraine by adding a dose of bioidentical progesterone. Different doses can be tried to find what works for you. Hormone balancing is not an easy task, although well worth it in the end. It is important to find a hormone doctor that understands how to use bio-identicals.

My doctors helped me find reduction in pain level and some relief in my hormonal migraines with bio-identical progesterone. I take progesterone at night in capsule form (which also helps me sleep like a baby), and drops under the tongue in the morning. I found having the same consistent dose everyday of the month, as well as twice per day rather than once, was what made a major difference for me.

Naratripan has also been a life saver for me on difficult months . When I take it for 3-5 days at the start of my cycle, it eliminates menstrual migraines completely. Take the time to find out what works for you. A hysterectomy or waiting for menopause is not the answer.