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What can be done for menstrual migraines?
Migraine headaches occur more frequently in women than in men, so you are not alone. Hormonal changes which occur throughout a normal menstrual cycle are one of many triggers. The first step in evaluating this is to speak to your obgyn (or primary care physician) for formal diagnosis, evaluation and discussion of possible treatment strategies. Even women who are most “attuned” to their bodies may be mistakenly diagnosing themselves, and this can be dangerous, and at the very least, ineffective in making you feel better.
Your doctor will take an in-depth history: Age of onset? Severity? Frequency? Duration? Location? Associated symptoms? Aura? Family history? Triggers? Right before your period, there is a decrease in estrogen, and this seems to be the cause of most menstrual-related migraines. Use of a headache diary may be helpful to indicate this hormone withdrawal as the trigger. There are several good smartphone apps for this.
To help, you may try over-the-counter products such as Advil or Tylenol. Changing some daily habits, such as stress management, optimizing sleep and exercise, minimizing alcohol or excess caffeine intake, and avoiding dietary triggers, may be helpful. Some dietary or herbal supplements may also be helpful: think B vitamins, magnesium, Butterbur, CoQ10. Some patients need migraine-specific medications prescribed by a neurologist.
For patients who have true menstrual-related migraines, who do not respond to other treatments, who have no medical contraindications, AND no aura preceding their migraines, continuous low dose birth control pills can be used to suppress periods and decrease headaches. Before considering this option, every patient should be assessed for age, family history, obesity, high blood pressure, cholesterol level, tobacco use, and pregnancy plans or need for contraception. For example, smoking is an absolute contraindication to the use of birth control pills in women over 35 who smoke. Staying in close touch with your obgyn remains important.