Do your migraines get worse with your period? You may have a condition called menstrual migraines.
It is pretty common knowledge that menstruation causes unpleasant symptoms for many people. Horrible cramps, fatigue, nausea, bloating, food cravings, and body aches are just a few of the symptoms menstruation brings each month. A lesser known symptom that somewhere between 40 and 70 percent of menstruating people that suffer from migraine attacks also experience menstrually-related migraines (MRM), also called menstrual migraines. Only about 10 percent of people with menstrual migraines reported only getting them immediately before or during menstruation.
It is difficult to determine just how many people get menstrual migraines because, according to neurologist Jelena Pavlovic, MD, PhD, they are “often underreported and underdiagnosed.” Why? Pavlovic surmises it is because the migraines start before a person’s period and stop before the period ends. Another reason is that the menstrual migraines is a “woman’s disease,” which are historically under researched. It is only in recent years that menstrual migraines have become recognized separately from other migraines, leading to improved diagnosis.
What makes menstrual migraines different from other migraines is that menstrual migraines are thought to be triggered by the fluctuations of estrogen and other hormones during someone’s monthly cycle. The standard theory is that they’re caused by the natural drop in estrogen prior to menstruation. The release of prostaglandin two days before the beginning of a period is another theory.
Menstrual migraines occur anywhere from two days before the start of a period and three days into a period. They’re typically more severe than normal headaches and are often accompanied with light sensitivity. While other migraines often come with an aura, menstrual migraines haven’t been found to produce them. Symptoms of menstrual migraines are very similar to migraines without auras, starting with a throbbing headache on one side of the head. Light sensitivity, nausea, and vomiting are also common with menstrual migraines.
It is difficult to diagnose menstrual migraines because there are no tests that can determine if someone gets them. Doctors will diagnose someone with menstrual migraines if they get migraines during two out of three menstrual cycles. At least “two out of four signature characteristics” and at least “one of two associated symptoms” are required for diagnosis. The four characteristics include throbbing, unilateral location, moderate to severe pain, and the headache getting worse after doing activity. The associated symptoms for diagnosis are light sensitivity, sound sensitivity, or both.
Deborah E. Tepper, MD of the Cleveland Clinic Center for Headache and Pain recommends keeping a journal to track your headaches and migraines. It is important to include where you are in your menstrual cycle, how bad the headache is, what treatment you use, and your response to treatments. Anne MacGregor, MD, specializing in headache medicine, created a chart people that suffer migraines can print and fill out to help keep track of their migraines. Keeping track of migraines and headaches can help doctors with diagnosis, assess “the effectiveness of treatments,” and find triggers.
Another thing that makes menstrual migraines different is that they don’t normally respond to medications used during the rest of the month for headaches and last longer and are more severe than other migraines. Dr. Tepper identifies three treatment plans for menstrual migraines, including acute treatment enhanced to hit menstrual migraines harder than usual migraines, mini-prevention that is a preventive treatment given before and during the menstrual window, and long-term prevention in which a daily preventive treatment is used throughout the month.”
Enhanced acute treatment include oral tablets, injectables, and nasal treatments. Dr. Pavlovic says that long-acting triptan, which can be taken in any of the three forms, can be used “preventively” and can be taken “beginning about a day before the expected onset of symptoms and continuing” until symptoms cease. Both a regular menstrual cycle and a headache journal to calculate when menstruation and migraines will begin are required for this method to work.
Taking a non-steroidal anti-inflammatory drug (NSAID) preventatively five to seven days “surrounding the menstrual window” can help decrease or even eliminate menstrual migraines. Taken in conjunction with triptan lessens the chance of severe menstrual migraines. Estrogen can also be supplemented through pills, patches, and gels to help offset the drop that naturally occurs before menstruation. Magnesium is also often prescribed to help prevent menstrual migraines, along with various forms of birth control. A doctor can help come up with the best treatment plan for you and your symptoms.