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.

WHAT CAN BE DONE ABOUT HORMONAL/MENSTRUAL MIGRAINE?

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.

Miscarriage, Migraine, and Muslim Jesus

October is Pregnancy and Infant Loss Awareness month. We have all experienced grief and loss in our lives. I am not the first person to go through this, nor am I the first to talk about it. This is my story.

Maybe my story is your story.

It was 2008 and my husband and I were living and working in Amman, Jordan. We had been trying to get pregnant and had exasperated multiple fertility methods to no avail. Our final try was IVF and this also failed.  A failed IVF can invoke the same feelings of loss and hopelessness as a miscarriage. This loss needs to be grieved. I was sad and feeling as though children were not in our future. I was also exhausted from the hormonal roller coaster and just wanted a break.

To our surprise within 3 months of the failed IVF, we found out we were pregnant. It seemed like a miracle, our miracle. The Arab Christian doctor I was seeing at the time brought me in every week for an ultrasound.  Every time he would smile and tell me things looked “good.” We were filled with hope and excitement; we were thankful and for the first time in years, I didn’t have a headache or migraine. This would become a common occurance for me in pregnancy, and years later would prove to be useful information as we worked to make sense of my complicated health and migraines.

Sometime around week 10 of this pregnancy I started spotting. My husband called the doctor immediately and the doctor was very quick to say the pregnancy was probably lost. We were shocked. How did he know this without looking? We went for a second opinion with a lovely Muslim doctor, and after a quick ultrasound, she told us there was no longer a pregnancy.  I had what is called a blighted ovum. Something, if seen on ultrasound can be diagnosed as early as 6 weeks. So we grieved our loss and felt betrayed. 

When my hormones crashed I got a horrible migraine that lasted over 2 weeks and I wanted to die.

Only a few months later, my period was late and I didn’t have a headache again. When it still hadn’t come a week later, I was sure I was pregnant. Over the course of another week, I took three pregnancy tests, but they were all negative.  And still my period never came. It was finally my Chinese acupuncturist, who during a session, told me I was absolutely pregnant. It didn’t matter if the tests were negative, he said. I had the body of a pregnant woman and should get a scan immediately. (This Chinese doctor would later tell me I was pregnant with a girl and he was right.) 

I was too afraid to dream. Too afraid to hope.  And then an ultrasound by my new doctor, Dr. Amal, showed in fact there was a pregnancy and a blood test later confirmed it. At the first ultrasound, we quickly knew how different this pregnancy was. There was a heartbeat.

Even so, I had an unsettling feeling the entire pregnancy. I had no reason, no evidence, but something just didn't feel right. And even through the first trimester as I vomited nearly every day, I couldn’t shake the feeling there was something wrong. So when I started bleeding, I was absolutely sure this was another loss. Instead an ultrasound showed everything to be just fine. A strong heartbeat and our daughter was moving around just fine. I decided I was just paranoid from the last experience and started buying maternity clothes.

Then on a Thursday morning at the end of October, I woke up and and I knew my baby was dead. My husband thought I was over reacting because I had no basis for these feelings. I demanded to go in for another ultrasound.  

It was dusk on that Thursday and the weekend in Jordan had already begun. The muezzin was calling for the evening prayer as we pulled into Farah Hospital. Dr. Zaid Kilani, the founder of Farah and an amazing man who is known all over the Middle East as a pioneer in the science of IVF, met us in the waiting room for the ultrasound. This was the first time I had met him, but I had heard stories of women miraculously getting pregnant under his care. He was a fertility miracle worker.

Dr. Kilani's white hair gave away his age and his eyes were kind and compassionate. His voice was soft and he spoke gently as he searched for a heartbeat on the computer screen.  We all stared desperately at the screen as moments passed and I knew the heartbeat was not there. When Dr. Kilani realized it also, he sighed deeply and began apologizing profusely. Dr. Kilani took us out in his private elevator and explained he wanted me to check in and go through labor and delivery that night. He explained he would do testing to find out what happened. I went along, but the weight of heartache oppressed me. I couldn’t do this, didn’t want to do it. I didn’t want to be there, I didn’t want to be in this hospital, this country. I hated the mother/child symbol on the wall in the Farah hospital. I pleadingly looked at my husband and wanted him to make it all stop. I cursed at God and cried. I felt abandoned.

I was checked into a room on the maternity floor, close to the nursery. An IV was started and medicine to induce labor. Dr. Kilani in his kind and apologetic words told me the goal was to deliver by the following day. He assured me he would not leave the hospital. I don’t remember much about that night or the following morning. I just remember faces. Faces of dear friends that came and sat with me, sometimes apologetically, sometimes saying nothing. There were friends that stayed the entire time I was in labor and pain. Friends that just sat in the mud puddle with me.

No one at that hospital would give me any form of pain medicine and I couldn’t figure out why, although I suspect they were scared of my complicated medical history. Eventually when it was over, I cried. I cried in relief. I remember someone asking if I wanted pictures and I definitely did not at the time. It wasn't something they did in Jordanian culture and I didn't want it.

Dr. Kilani with his kind voice and eyes showed her to me and pointed out what he could see wrong. The intestines were outside of her belly.  He still needed to do testing and without saying the words exactly, he very kindly inferred it was better this happen rather than to carry all the way to full term. And then he reassuringly told me in his entire career, he could count on two hands how many times he had seen a situation like this. It was one in a million and unlikely to happen again. His words were prophetic and he reminded me of Jesus. Dr. Kilani was my Muslim Jesus. And because he knew we had already been through so much, he allowed my husband to stay with me and hold my hand while they put me to sleep and did a D&C.

I was alone in my room as my husband walked with friends who were leaving. I was crying and hopeless, wondering how we would ever recover. And very quietly Jesus visited me and said, Not this time N, but next time. I sighed. And then Muslim Jesus entered my room and boldly told me this wasn’t the end of my story. I would get pregnant again. I would have a baby, and he wanted to be the doctor to deliver it. He patted my leg and told me I was free to go home and rest.

In the weeks that followed, I spent as much time as possible in our apartment, sometimes with all of the shades down and curtains closed. I didn’t want to be alone and I didn’t want to be around anyone. I hated God and I hated everyone else.  After two weeks, Dr. Amal called to let us know the baby had Trisomy 18 and would not have lived much after birth. I was in hormone hell and got a horrible migraine that lasted for what felt like a month. It was a daily reminder to me of death and I couldn't find God in any of this.

Sometimes I would awaken in the dark hours of night and scream out, remember and start sobbing again in the darkness. My husband would hug me, speechless and hurting himself. Grief is always the darkest in the night and it was in those moments I contemplated taking my own life and pleaded for God to just take me. But morning always came. Numb, we muddled through our lives the following months. My doctor suggested we start trying again after 2 cycles, but I just couldn’t. I felt choked by fear and I didn’t want another baby, I just wanted the one I had lost.

People said a lot of dumb things to me during this time, and a lot of ridiculous religious clichés. I have always been fairly real, real with people and real with God. I think God appreciates realness, so I told him daily exactly what I thought of my situation.

It is in our deepest pain, both physically and emotionally we come to see the face of God.

By other people I often felt judged by how I was responding to my situation, or choosing not to respond. I was judged by the things I said out loud; by what books I was reading or not reading. I was judged by everything I did or didn’t do. If I had been a Muslim, I would have been expected to say, “It was God’s will,” and not cried or questioned, lest God bring something even darker upon my life. Seemingly the same, as a Christian, I learned I was expected (by other Christians) to respond nearly the same. Could God not handle my words or thoughts? He could. When something horrific happens, often well-meaning people show up and start talking. They speak as God’s advocate, thinking they need to defend Him, as if He can't defend Himself. Knowing when to just sit silently next to a person in the mud puddle, in the mud puddles of life, is a skill few people have. The friends who did, who sat quietly in the mud puddle with me, are a treasure and I will never forget them. 

My husband planned a nearly three week trip to Turkey in January of 2009 and I felt like I could breathe again. It didn’t fix anything, it didn't heal me, but it helped me process. And when we returned to Jordan, I decided I would try again with fertility treatments. Only a few short months later we were pregnant with twins and they were born the following October, almost exactly one year later. Two beautiful miraculous gifts that were not given to replace the ones we had lost, but were just simply given and entrusted to us. And then a few years later a third little miracle, a baby girl, joined our family and we finally felt complete.

My story has a happy ending and I realize it doesn’t always happen this way for everyone. But I do know there is always hope. In every horrific situation we will eventually find hope, because the worst is never truly the end.