Menstrual migraine - real pain, real solutions

It's incredible how misunderstood Menstrual Migraine still is today. In spite of many years of progress in migraine research, there is still far too much misdiagnoses and poor treatment taking place. But, slowly, that is changing.

There are actually two different types of these migraines. First, there is what has been called "pure" or "true" Menstrual Migraine. But also there is Menstrually Related Migraine or Menstrually Associated Migraine. We're going to look at both.

Men and Women - the difference

By now many people know that women are much more likely to have migraine attacks than men. Why? The answer may seem obvious - hormones, right? Well, yes and no. Hormones do play an important role, but research is still questioning just what role they play. Take for example this study into cortical spreading depression.

Though migraine does not seem to be caused by hormonal changes, those changes may trigger attacks. It's estimated that 60-70% of migraine attacks in women are menstrually related. The attacks occur before, during, or right after their period, or during ovulation.

But what's causing the attack?

Right before your period, levels of estrogen and progesterone drop sharply. Most often researchers suggest that it's the change in estrogen that's triggering the menstrual migraine attack. This is why going off birth control pills can cause attacks as well, since they cause changes in levels of estrogen.

But your body goes through other changes during the monthly cycle. For example, a 1981 study published in the American Journal of Clinical Nutrition found that magnesium levels were low in patients who were experiencing premenstrual symptoms.  (Study abstract:  Serum and red cell magnesium levels in patients with premenstrual tension.)  The magnesium migraine connection is well known.

But back to estrogen. Again, we're not sure exactly why the migraine attack is triggered. But we do know that estrogen levels cause a change in levels of serotonin, a neurotransmitter. Low levels of serotonin have been linked to migraine for some time.

Serotonin influences blood vessel constriction, mood, and can impact the way we feel pain. It's not a stretch to see the connection.

Menstrually Related Migraine (MRM)

Menstrually Related Migraine, or Menstrually Associated Migraine, are migraine attacks that can actually occur any time of the month, though they do seem to be related to the regular hormonal changes in your body. To fit the criteria set by the International Headache Society, there must be a migraine attack (without aura) 66% of the time or more around the time of your period (the 5 day perimenstrual period).

Usually there is a severe headache involved, and other migraine symptoms such as nausea, and sensitivity to light and/or sound.

True Menstrual Migraine

Pure Menstrual Migraine has the same symptoms, but only occurs during your period (or at least 66% of the time it does). (Again, this is during the 5 day perimenstrual period - from day -2 to day +3)

The bad news is that migraine attacks hitting during your period tend to be more resistant to treatment, more debilitating and longer lasting than attacks at other times of the month.

Do I have it?

It's important to take the time to keep a migraine diary to see if you have MRM or menstrual migraine. On the diary, keep track of your monthly cycle, and your migraine symptoms.

It's also important to note if you've experiences migraine aura. Typically, it's the migraine without aura that we're interested in when it comes to MRM and menstrual migraine, because it's this type of attack that will tend to rise during your period.

This diary will become a key tool for you and your doctor to use to find the best treatment for you.

Treatment

First, let's talk about the less-successful treatments. First, a hysterectomy does not seem to be a good answer. Not only is there no guarantee it will help, women often find that their attacks get worse.

Hormone therapies have been tried, but the jury is still out on how successful they will be.

Another treatment has been to actually stretch the time between periods, using, for example, certain birth control pills.

Much of the treatment is the same as for any migraine. NSAIDs (Nonsteroidal Anti-inflammatory Drugs - such as ibuprofen) are often used to treat the pain of attacks.

A better solution for migraine tends to be the triptan drugs. There are many available, and it's wise to try more than one if the first doesn't help. Eletriptan (Relpax) has been popular in treating menstrual migraine, as has frovatriptan (Frova). These have been tried both as an abortive (when the attack hits) and a preventative (taken around the time of your period).

For more about the general types of help available, read Treatment for Menstrual Migraine.

Of course, it's wise to try many of the non-drug treatments that are available. Find more basic migraine treatment information here.