Migraines and Women
March 15, 2010
Dr. Jan Lewis Brandes
News notes via www.webmd.com
Migraines, Headaches, and Hormones
It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report that their migraines are related to their menstrual cycles -- hence the name, menstrual migraines.
What Is the Relationship Between Hormones and Headaches?
Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman's menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow.
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% 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 Hormonal Migraines in Women?
Birth control pills as well as hormone replacement therapy during menopause have been recognized as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking birth control pills, especially those containing high doses of estrogen.
The frequency of side effects, such as headache, decreased in those who took birth control pills containing lower doses of estrogen and did not occur in those who took birth control pills containing progesterone.
What Are the Treatment Options for Menstrual Migraines?
The medications of choice to stop a menstrual migraine are nonsteroidal anti-inflammatory medications (NSAIDs).
The NSAIDs most often used for menstrual migraines include:
NSAID treatment should be started two to three days before the menstrual period starts and continued until the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.
For people who have severe menstrual migraines or who want to continue taking their birth control pills, doctors recommend taking a NSAID, starting on the l9th day of the cycle and continuing through the second day of the next cycle.
Other drugs that may be used are given by prescription only. They include:
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 a woman's period, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt-intake immediately before the start of menses.
Lupron is a drug that affects hormone levels and is used only when all other treatment methods have been tried and have been unsuccessful.
What Are the Treatment Options for Menopausal Migraines?
For people who need to continue post-menopausal estrogen supplements, the lowest dose of these agents should be used, on an uninterrupted basis. Instead of seven days off the drug, you should take it on a daily basis. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may also be effective in stabilizing the levels of estrogen.
What Are the Treatment Options for Migraines During Pregnancy?
During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these drugs should be strictly avoided during pregnancy.
A mild pain reliever can be used, such as Tylenol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists before taking anything.
What are cluster headaches?
Cluster headaches are severe, one-sided headaches that happen in groups, or "clusters." They usually occur over weeks or months.
Cluster headaches can be so painful that you are not able to follow your normal routine or do your usual activities. The pain is often called the worst type of headache pain.
Cluster headaches come in cycles (also called cluster periods). Most people who get cluster headaches have one or two cluster periods each year. A cluster period might last 1 month or longer. After a cluster period ends, you may not get another headache for months or even years.
As you get older, it is likely that you'll have longer and longer times without headaches. At some point, you may not get cluster headaches ever again.
Having cluster headaches can be scary. But even though they are very painful, cluster headaches don't cause long-term harm. During a cycle, you may be able to reduce how often you have them, how bad they are, and how long they last.
What causes cluster headaches?
Experts aren't sure what causes cluster headaches. They run in families, but it's not clear why some people get cluster headaches and others do not.
What are the symptoms?
The main symptom of cluster headaches is a severe burning or sharp, piercing pain on one side of your head. The pain spreads out from your temple and eye. Your eye may become red, watery, or puffy. The eyelid may droop, and you may have a runny or stuffy nose on that side of your head.
See a picture of cluster headache symptoms .
The pain usually gets bad very fast. The pain gets worse within 5 to 10 minutes after the headache starts and can last for 30 minutes or longer.
Cluster headaches usually happen at the same time of day each time you get them. But they can happen at any time. You may have 1 to 8 headaches a day.
How are cluster headaches diagnosed?
A doctor can usually tell if you have cluster headaches by asking about your symptoms and examining you. You probably will not need tests such as a CT scan or an MRI. Your doctor may order other tests if he or she thinks your symptoms are caused by another disease.
How are they prevented and treated during a cycle?
There is no cure for cluster headaches. You can't do anything to prevent a cycle of cluster headaches from starting.
But as soon as a cycle starts, you can take medicine that may help prevent more headaches or reduce how many you have during a cycle. You take this medicine every day during the cycle.
Certain things may be more likely to cause a headache during a cycle. These are called triggers. Avoiding them may help prevent headaches. Triggers include:
When a headache starts, you can take medicine or breathe in oxygen from a machine to ease the pain or stop the headache. You use these treatments only when you feel a headache coming on. You don't use them every day.
When a cluster headache begins:
If your treatment doesn't work, ask your doctor if you can try something else. It may take time to find what works best for you.
A headache diary can give you and your doctor clues to help you manage your headaches. Write down when and how often the headaches happen, how severe they are, and what you think may be causing them. Share this with your doctor.
What is a tension headache?
Most headaches are tension headaches. These headaches tend to happen again and again, especially if you are under stress. They are not usually a sign of something serious. But they can be very painful and hard to live with.
What causes tension headaches?
Doctors don't know for sure what causes tension headaches. In the past experts thought that tension or spasms in the muscles of your neck, face, and head played a role. Now they think a change in brain chemicals may also be a cause.
What are the symptoms?
Symptoms of tension headaches include:
This is different from migraine headaches, which usually cause throbbing pain and start on one side of your head.
Tension headaches tend to come back, especially when you are under stress. They can last from 30 minutes to several days.
Usually, pain from a tension headache is not severe and does not get in the way of your work or social life. But for some people the pain is very bad or lasts a long time. You have chronic tension headaches if they occur at least 15 days a month.
How are tension headaches diagnosed?
A doctor can usually diagnose tension headaches by asking you questions about your health and lifestyle and by examining you.
How are they treated?
But if you take these pain relievers more than 3 times a week, you may get rebound headaches. Rebound headaches are different from tension headaches. They usually start after pain medicine has worn off, which leads you to take another dose. Eventually you get a headache whenever you stop taking the medicine.
Some people have chronic tension headaches. This means they often get headaches. Doctors may prescribe stronger pain medicine for these people.
Can tension headaches be prevented?
Even with treatment, most people still have some headaches. But with treatment, you will probably have them less often. And when you do get them, they probably won't be as bad.
Home treatment may help you avoid headaches. Learn how to handle stress. Make sure you sleep, exercise, and eat on a regular schedule. Check your posture. Don't strain your eyes when you use your computer. Get treatment for depression or anxiety.
Try keeping a headache diary. Every time you get a headache, write down the date, the hour, and what you were doing and feeling before your headache started. This may help you and your doctor find out what is causing your headaches so you can get the right treatment.