Menstrual Migraine

Definition

Menstrual migraine refers to migraine headaches that generally or exclusively occur around the time of menstruation. Menstruation is one of the most common and powerful migraine triggers. Women with menstrually associated migraine may experience migraine at other, random times, though these are not usually as severe.

Why is menstruation a trigger?

It appears that a rapidly dropping estrogen level is a trigger for migraine. Experiments that involved control of progesterone levels did not prevent menstrual migraine. In addition, prevention of sudden drops in blood estrogen levels, through the use of medications, commonly reduces or prevents menstrually associated migraine.

Specific Treatments

Estogen Patch

This patch can be applied just prior to menstruation or just prior to the time of headache onset. Drug treatment should be continued for about a week.

Some women may know menstruation will occur because they are on birth control pills and are about to take their placebo pills. In these cases, the patch can be started when the first placebo pill is taken.

For others, they may experience mild headaches, poor mood, breast tenderness, swelling, bloating, or difficulty concentrating - signaling impending menstruation - this is also the time to begin the patch.

For others, menstruation and headaches are so predictable that they can safely put the patch on one day prior to the predicted day of first headache.

Reduced Cycling Birth Control

Some women find it helpful to start birth control pills and then avoid taking placebo pills for three months. This essentially avoids the migraine trigger by avoiding menstruation altogether (or for at least three months). Many Ob/Gyns feel it is reasonable to reduce menstrual cycles even more than this - though you should discuss the potential risks with your own physician.

Unfortunately, while this may help to reduce menstrual migraine, for some women this leads to an increase in migraines occurring at other, random times. One way to reduce this risk is to use a monophasic pill - that is - a pill which contains the same dose of medication throughout the month.

Triptan Medications

Triptans are a group of medications usually used to treat a migraine once it has started. Two of the longer-acting triptans (Frova, Amerge) have been successfully used in a preventative manner for menstrual migraine. Women may take the medications twice a day on headache-predicted days. They can stop taking the medications after 5-7 days, when they should no longer be at risk.

Standard Preventatives

In my experience, standard preventative medications aren't able to prevent migraines that are associated with menstruation, probably because it is too powerful of a trigger. Standard preventative medications include beta-blockers, valproic acid, tricyclic antidepressants, calcium channel blockers, and Topamax - they are discussed in depth on the migraine treatment page.

On the other hand, standard preventatives do tend to reduce the intensity of migraines, which can be very helpful. Also, these medications can sometimes be increased in dose around the time of menstrual migraines, with a further reduction in headache intensity.

General Advice

Not all cases of migraines associated with menstruation can be cured. Some general advice is to especially avoid any known triggers during menstruation. Try to get enough rest, be well-hydrated, and avoid alcohol. Also, be prepared with those treatments that you know are effective, and treat the migraine early if it arrives.

It is also important not to give up trying various options, as often you will eventually find something that works.

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