Menstrual Migraines – Causes, Symptoms, and Treatment…

Many women report an increase in the frequency of migraine headaches in occurrence with the perimenstrual period. Many patients that I have seen used to call any severe headache they had a ‘migraine headache’. However, migraine headaches have some unique qualities which distinguish them from other headaches such as tension headaches.

What Are the Symptoms of Migraine Headaches?

1. Migraine headaches are most commonly on one side of your head vs tension headaches which are bilateral.
2. Migraine headaches often have a throbbing quality.
3. Migraine headaches are often accompanied by either sensitivity to noise, light, smell, or various combinations of these.
4. Migraine headaches are often preceded by a prodrome which can include a change in mood or fatigue.
5. Many patients who have migraine headaches often notice that it is preceded by an aura which can include blind spots in their vision called scotomas, or they may see flashing colorful lights.
6. Migraine headaches often include Nausea/vomiting as a symptom.

What Causes Menstrual Migraines?

Estrogen fluctuations, in particular, their premenstrual fall, are generally regarded as the main triggers of menstrual migraine.

Treatment Options:

“Acute management of menstrual migraine should initially be abortive and primarily sought with triptans. If this fails, short-term perimenstrual prophylaxis with NSAIDs, coxibs, triptans or ergotamine derivatives can be considered. Hormone manipulations, mainly application of percutaneous estradiol gel in PMP or administration of oral contraceptives in extended cycles, constitute an alternative approach for nonresponders” (Allais et al, 2007).

Summary from Allais et al:

1. Triptans–e.g. Sumatriptan–selective serotonin 5-HT1B/1D agonists.
2. NSAIDS–Non-steroidal Anti-Inflammatory Drugs, e.g. naproxen, ibuprofen.
3. Ergoatamine–e.g. Cafergot (with caffeine).
4. Percutaneous Estradiol gel for non-responders.

References:

1. Allais G, Castagnoli Gabellari I, De Lorenzo C, Mana O, Benedetto C. Menstrual migraine: clinical and therapeutic aspects. Expert Rev Neurother. 2007 Sep;7(9):1105-20.