Menstrual migraine is by no means exotic. And the most common example of female headache. Almost 60 percent of women say that before menstruation their head begins to hurt somehow differently. There are two types of diseases – “pure menstrual migraine” and “menstrual-associated migraine”. Their differences need to be known in order to be able to competently cope with attacks.
In the first case, a headache appears two days before menstruation and in the first two to three days of the cycle. Such migraines occur in at least two out of three cycles and do not occur in other periods.
Menstrual bouts are almost twice as long and more difficult to anesthetize.
If headache attacks also occur at another time of the cycle, often in its second half, then such a migraine is considered to be menstrual-associated. Usually these are bouts of pain without aura, it is accompanied by nausea, light and sound phobia. Like all migraines, they severely limit female activity.
Migraine, myoma, endometriosis
Often menstrual migraines are combined with the gynecological problems of women. In the first place among them is premenstrual syndrome. The harder it goes, the stronger the headaches. Next come endometriosis, uterine fibroids, ovarian dysfunction and, as a result, infertility. With this combination of problems, a woman is often treated immediately by two specialists – a neurologist and a gynecologist-endocrinologist.
The fact is that the very appearance of menstrual migraines is associated with a change in the female hormonal background. A headache attack occurs when at the end of the cycle a woman’s levels of sex hormones – estrogen and progesterone – drop sharply. And, therefore, the additional introduction of hormones with drugs can be a logical solution to the problem.
The same phenomenon of migraine return is observed in women and after childbirth. During pregnancy, with a consistently high level of hormones, seizures most often recede. But after the birth of a child, the level of estrogen decreases, and, alas, migraines again make themselves felt.
To diagnose menstrual migraine, no complicated studies are needed. It is enough to keep a diary of a headache for three cycles. Based on it and a story about yourself, it will be easy for an experienced doctor to make a conclusion and prescribe treatment.
The treatment strategies for “hormonal migraines” depend on the time of their appearance, frequency and susceptibility to drugs.
If the attacks are rare, you can only use painkillers — right at the beginning of the attack. It can be simple or combined analgesics or special anti-migraine painkillers – triptans.
If the seizures are frequent, and the pills help poorly, plus days with a headache can be predicted, preventive treatment is used. It is carried out according to one of two schemes – short-term or long-term.
The essence of short-term therapy is that 2-3 days before the expected menstruation, a woman begins to use a certain drug. And he continues to do this for a week.
Long-term therapy is used in more complex cases. And as the name suggests, it lasts for three to six months.
Moreover, the choice of specific drugs and their forms depends on the type of hormonal migraine. If this is a true menstrual migraine, then the non-steroidal anti-inflammatory drugs and sex hormones are the drugs of choice. In addition to affecting headaches, they improve the state of concomitant gynecological problems.
If attacks of pain overtake a woman not only during menstruation, but also on other days of the cycle, standard preventive therapy of migraine is used. That is, not hormones or anti-hormones, as in the first case. And vascular agents, antidepressants, anticonvulsants or ergotamine drugs. They are selected by a neurologist taking into account other female problems – the presence of hypertension, depressive disorders, an individual pain threshold.
In addition, completely new preventive measures for migraines are now being introduced into medical practice. They relate to biological therapy.
If a short outline is ineffective or for some reason does not suit you, another – a long-term strategy comes to the rescue. It involves taking combined oral contraceptives in a continuous three-month regimen.
In other words, a woman drinks three packs of the drug in a row without a traditional break for menstruation. However, in her body does not occur that sharp drop in the level of hormones that occurs on the week of withdrawal. And menstrual migraine does not appear.
True, some gynecological diseases limit the use of contraceptives. Then, pure progestogens are prescribed instead. They are represented by the so-called tablets, intrauterine system and long-acting depot injections. Some remedies are good for women with postpartum migraines or planning a pregnancy. Others are more suitable for those who are not going to give birth.
The relationship of migraine and hormonal changes
Menstrual migraine often develops in women with an early start of menstruation. Especially if the girl was disturbed by headaches even before puberty. By the age of 13, headaches develop into a migraine. And the peak of menstrual migraines falls on the 35th anniversary.
Whatever treatment regimen your menstrual migraine chooses for you, it’s important not only to take pills or stick on a patch. It is necessary to observe the regime of work and rest. Do not overwork emotionally and physically. Do not eat foods or drink beverages that can cause a headache. Such food provocateurs include red wine, chocolate, citrus fruits, cheese, salted herring and nuts.