Menstrual-Associated Migraines

I often get painful headaches around the time of my period? Is this normal? What can I do about them?

Your complaint is a common one. About 10-20 percent of all women experience headaches of varying severity that occur around their menstrual periods. Menstrual migraines are defined as headaches that only occur any time from 2-3 days preceding to 2 days into a period. Menstrual-associated migraines can occur during the above times, but also at other times during the month. It is believed that menstrual headaches are associated with a relative decrease in circulating estrogen. This may cause blood vessels in the brain to be more susceptible to other biochemicals involved in producing migraines.

What can be done to help? If you are troubled by headaches throughout the month, you may want to talk with your primary care provider or perhaps a neurologist about potential migraine triggers (certain foods, lack of sleep, stress) and medications to help prevent headaches and/or treat them when they occur. If your major problem is the menstrual headaches, there are several approaches. Though these measures may not prevent menstrual headaches, it is always helpful to get adequate sleep, exercise regularly - and avoid certain food triggers such as red wine, cured meats and hot dogs, and aged cheeses. Some small studies have reported success with cyclic (taken continuously from 2-3 days before a period to 3 days into a period) magnesium--360 mg daily or cyclic ibuprofen/Motrin--400-600 mg every 6 hours.

Other prescription treatment options include traditional migraine medications such as Imitrex/sumatriptan--cyclic dosing of this showed an 80 percent reduction in headache symptoms in one study. Birth control pills can also be used to avoid the drop in circulating estrogen that occurs with a period if used continuously (i.e., the placebo pills are skipped each month and only hormone containing pills are used). I have had very few patients who have not been able to significantly reduce their menstrual headaches with one or a combination of the above methods, but it is critical to tailor therapy to an individual patient. Not all therapies work for everyone.

One caveat--there does appear to be a very small increase in stroke risk in women who have migraines with aura (prodromal changes in vision such as "dancing lights" or partial visual loss that precede headaches). This risk can be increased with cigarette smoking, a family history of stroke or blood clots, high blood pressure, and slightly with estrogen-containing birth control pills. Though they are safe for most women, be sure to work with a health care provider when starting birth control pills for menstrual migraines.

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