It has been estimated that 70% of migraine sufferers
are female. Of these female migraine sufferers, 60% to 70% report a menstrual
relationship to their migraine attacks.
What is the relationship between hormones and headaches?
Headaches in women, particularly migraines, have been related to changes in
the levels of estrogen during a woman’s menstrual cycle. (Estrogen is a female
hormone.) Levels of estrogen drop immediately before the start of the menstrual
flow (menses).
Premenstrual migraines regularly occur during or after
the time when the female hormones, estrogen and progesterone, decrease to their
lowest levels.
Migraine attacks typically disappear during pregnancy.
In one study, 64 percent of women who described a menstrual link to their
headaches noted that their headaches disappeared during pregnancy. However, some
women have reported the initial onset of migraines during the first trimester of
pregnancy, with disappearance of their headaches after the third month of
pregnancy.
What triggers migraines in women?
Birth control pills, as well as hormone replacement therapy for menopause,
can change the frequency or severity of headaches. If you notice your headache
getting worse after starting one of these medications, it may be worthwhile to
ask your physician for an agent that contains a lower dose of estrogen, or
request a change from an interrupted dosing regimen to a continuous one.
What are the treatment options for menstrual migraine?
The medications of choice in the treatment of menstrual migraine are
non-steroidal anti-inflammatory medications (NSAIDs).
The NSAIDS most often used for menstrual migraine include:
- Ketoprofen (Orudis®)
- Ibuprofen (Advil® and Motrin®)
- Fenoprofen calcium (Nalfon®)
- Naproxen (Naprosyn®)
- Nabumetone (Relafen®)
Therapy with the NSAID should be started two to three
days before the onset of the menstrual flow and continued through the flow.
Because the therapy is of short duration, the risk of gastrointestinal side
effects is limited.
Other medications prescribed include:
- Small doses of ergotamine (including Bellergal-S®) or a
similar compound, methylergonovine maleate (for example, Methergine®)
- Beta blocker drugs such as propranolol
- Anticonvulsants such as valporate
- Calcium channel blockers such as veraperamil
These drugs should also be started two to three days
pre-menses and continued throughout the menstrual flow.
Because fluid retention is often associated with
menses, diuretics have been used to prevent menstrual migraine. Some physicians
may recommend that the patient follow a salt-restricted diet immediately before
the start of menses.
Leuprolide (Lupron®) is a medication that
affects hormone levels and is used only when all other treatment methods have
been tried and have been unsuccessful.