Migraines

A migraine is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea and/or vomiting; sensitivity to light, sound, and smells; sleep disruption and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.

Between puberty and menopause, migraines are 2-3 times more common in women than in men. Some women experience migraine headaches just prior to or during menstruation. These headaches, which are called menstrual migraines, may be related to hormonal changes and often do not occur during pregnancy. Other women develop migraines for the first time during pregnancy or after menopause.

Up to 25% of women have migraines during their reproductive years. In 60% to 70% of cases in women, the headaches are related to the menstrual cycle. They occur before, during or immediately after the period, or during ovulation. The medical community divides these hormonal migraines into two categories.

• True Menstrual Migraine - attacks that occur two days prior, during and up to three days after the menstrual period and at no other time.
• Menstrually Related - attacks that occur during mid-cycle or around the time of ovulation.

Are Migraines Just Another Part of PMS?

Both menstrual migraine and PMS are driven by a woman's hormonal cycle and affect her nervous system, however, the cause of each is thought to be different.

Serotonin is the primary hormonal trigger in headache, and some researchers believe that those who have migraines inherit a disorder that somehow affects the way serotonin is metabolize. For women, however, menstrual migraines are primarily caused by estrogen and the way it interacts with serotonin. When levels of estrogen and progesterone change during the menstrual cycle, women become more vulnerable to headaches. That is why women taking oral contraceptives that influence estrogen levels may experience more menstrual migraines.

Treatment

There are two goals when treating any type of migraine or other headache: to relieve the pain and prevent future attacks. It will help your healthcare provider determine appropriate treatment if you begin to identify circumstances or factors that trigger your migraines. Keep a daily calendar of your menstrual cycle, symptoms, foods, beverages, prescription and over-the-counter medications, physical and environmental factors, stressful situations, sleep patterns, and characteristics of the headache itself.

Saliva hormone testing is another important tool your healthcare provider can use to determine treatment. ''Cycle mapping'' utilizes saliva hormone testing to measure both estradiol and progesterone levels at 13 points throughout a 28 day cycle. With this ''map'' of your hormone levels and your daily calendar, your healthcare professional can make a complete evaluation to develop plan of treatment, which may include prescription hormone therapy.

The most common types of hormone therapy prescribed for migraine are natural estrogen and progesterone. Estrogen works to increase the level of serotonin and endorphins, as well s other neurotransmitters which aid in migraine management. Although estrogen is not as commonly used in premenopausal women, it is prescribed in certain situations and most often given cyclically. Typically, transdermal dosing is used which maintains a constant level of estrogen in the blood, avoiding the peaks and valleys that appear to trigger the migraine.

Progesterone is the primary hormone treatment of choice for PMS and is important for migraine management both pre- and post-menopause since it helps to balance estrogen levels. Oral extended release tablets are preferred as it is most effective with symptom management.

Non-hormonal treatments are often prescribed in addition to hormones. Information about these should be obtained from your healthcare provider.