Migraines occur far more frequently in women than men. In fact, in adult women the rate of frequency is roughly 15% – 17%, where in men it’s only about 5%.
Menses and Migraines
Studies have shown that it is the withdrawal of estrogen that is a key factor in migraine headaches which are related to menstrual cycles. 25% -30% of all women in their 30’s experience at least an occasional migraine. Menstrual migraines generally last longer than non-menstrual migraines, and often are much more difficult to treat effectively. 60%-70% of women who suffer from migraines have menstrual related migraines. 10%-14% of women with migraines have them only during menstruation. These types of headaches are known as “true menstrual migraines.”
Pre-Menstrual Migraines
Pre-menstrual migraines may in fact be part of pre-menstrual syndrome (PMS). Another disorder, Pre-Menstrual Dysphoric Disorder (PMDD), is considered by many to be the most severe form of PMS. PMDD affects 3-8% of women. Symptoms of PMS include but are not limited to: fatigue, irritability, depression, bloating and headaches.
Pre-Menopause and Menopause
Two-thirds of women who have suffered from pre-menopausal migraines find their condition improves with menopause. On the other hand it has also been found that surgical menopause (removal of ovaries before the age of menopaus3e) may worsen migraine conditions.
Treatment options for menstrual migraines
When choosing to treat menstrual migraines with medication, the drugs used most often are non-steroidal anti-inflammatory or NSAIDs. The NSAIDs most commonly used in treating menstrual migraines are ketoprofen (Orudis), Ibuprofen (Advil & Motrin), fenoprofen calcium (Nalfon), naproxen (Naprosyn) and nabumetone (Relafen).
For best results when using NSAIDs to treat migraines, the medication should be started at least 24 hours before menstrual flow actually begins. This therapy should be continued throughout the menstrual period. This of course assumes that your periods are regular and predictable. Gastrointestinal (stomach) side effects are the most frequent problems. However, these are generally not serious enough for most women to discontinue the medication because it is used for such a short period of time. If the gastrointestinal side effects are an issue, consult your physician.
For patients who suffer more severe menstrual migraines or who are able to continue taking oral contraceptives (birth control pills), your doctor may also recommend taking NSAIDs along with these.
Some women find that anti-nausea (anti-vomiting) medicines and pain relievers such as, aspirin, ibuprofen, acetaminophen (Tylenol) are effective enough to dull the pain. Others place their trust in algesics or serotonin agonists like Imatrex, Zomig, Amerge or Maxalt. When using any medication, it is extremely important to be aware of the potential side effects of your medications. You should become aware of the dangers of avoiding a repetitive pattern of medications or re-use of medications as this can cause rebound headaches. Rebound headaches occur when your headache returns or worsens after you have discontinued your medication.
Your physician may also consider using an estrogen skin patch. This treatment is usually utilized on the days leading up to your period and may help either delay, or in some cases prevent, the onset of the menstrual migraine.
A few small studies have found that daily doses of magnesium may help menstrual migraines in certain women. Additionally, vitamins and herbal treatments have been found to be affective for some women. The herb Feverfew or Vitamin B2 when taken on a daily basis may reduce either the severity or the frequency of the headaches, though research has none been done for menstrual migraines in particular.
As mentioned previously, about two-thirds of women report improvement in their migraine condition with the onset of natural menopause. However, two-thirds of women report a worsening of their headaches with surgical menopause. This means that neither a hysterectomy nor ovarian removal (oophorectomy) is recommended as treatment for migraine headaches.
As always you should consult your physician for proper diagnosis before beginning or discontinuing any kind of new medication, including the treatments that you buy over the counter without a prescription. Every person has a unique health profile that includes aspects specific to their physiology and family history and that may keep them from taking certain medications.
Finally…
There are many, many different migraine triggers. The most important recommendation that I can make to you is that if you have frequent migraines, keep a trigger diary that includes a record of foods you eat, the weather conditions, medication you have taken, stressful events, menstrual activity, etc.
You will also benefit by developing a plan around your periods, if you have menstrual migraines. Reduce stress as much as possible, like planning work and leisure commitments around your cycle, so you can try to decrease menstrual related triggers as much as possible.
*Medical Disclaimer: The information in this article is to be used for general informational purposes only. It should not be used in place of professional medical advice. If you have further specific questions, you are urged to consult with your personal physician for additional information.
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