Treating menstrual migraine

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Pre-empting headaches can transform the lives of menstrual migraine sufferers.

Migraine headaches can induce debilitating pain, causing people to miss work or school and negatively affecting their quality of life. Of all types of migraines, those associated with menstruation tend to be the most severe, longest lasting, most disabling, and most difficult to treat.

In fact, according to the World Health Organization (WHO), migraine is among the world's top 20 leading causes of disability. Repeated migraine attacks not only affect a person during an attack but between attacks.

Dr Elizabeth Loder, an associate professor of Neurology at Harvard Medical School and chief of the Division of Headache and Pain in the Department of Neurology at the Brigham and Women's/ Faulkner Hospitals in Boston, observes: "Many chronic migraine sufferers can't make plans or go to social events, because they don't know when they will have their next headache. Although people seem like they are fine between the headaches, they have a decreased quality of life because they are always anxious about when the next headache will arrive."

The long-term effort of coping with chronic migraines may also predispose a person to other illnesses. For example, depression is three times more common in people with migraine or severe headaches than in people without migraine.

During childhood, more young boys have migraine than girls, but this changes at puberty. After puberty, migraine eventually affects women three times more often than men. This sex difference increases with age, peaking during the early 40s, then declining.

Hormones, especially oestrogen, appear to modulate migraine activity. It is now thought that the oestrogen withdrawal that occurs just prior to the onset of menses is the trigger for headaches that occur just before a woman gets her monthly period.

Effective treatments have been shown to reduce the impact of menstrual migraine once an appropriate diagnosis is made. Yet despite the high prevalence of menstrual migraines among women of childbearing age, health professionals routinely fail to effectively diagnose and treat the condition.

Dr Loder explains, "For centuries the focus was on waiting until the headache came, and then taking something to make it better or go away. While that strategy works well for a lot of people, especially those who don't have headaches very often, a sizeable minority have very frequent headaches and, for them, that strategy can backfire."

People who take headache medication frequently may end up with "medication overuse headaches", which can make headaches more frequent. In addition, acute treatment does nothing to address the anxiety endured between attacks.

A more effective strategy for these people involves pre-empting attacks. Most women with menstrual migraine have predictable attacks between two days before and three days after the start of menses.

This allows them to take medication before the headache begins, thereby preventing the attacks or at least lessening their severity.

Dr Loder says, "The idea of stopping the headaches before they begin is a new idea that has transformed the lives of countless headache sufferers."

Behavioural and lifestyle changes

Women with migraine are generally more susceptible to dietary, physical, and environmental triggers for migraine attacks during the week before and the first few days of their period. Some non-pharmacological ways women may prevent migraines associated with these triggers include:

• Eating regularly scheduled healthy meals
• Staying hydrated
• Getting consistent and regular sleep
• Getting regular exercise
• Learning stress-reduction techniques
• Avoiding dietary triggers (eg. caffeine and alcohol). It's a good idea for these women to keep a food diary to observe any additional trigger foods and avoid them as well.

Most menstrual migraine attacks are the result of several of these triggers building up over the cycle. The menstrual trigger is the final one to trigger an attack.

For some women, eliminating migraine triggers reduces the frequency and severity of all attacks. For others, it only eliminates the non-hormonal attacks while the menstrual attacks persist. Often this approach works best when combined with pharmacological treatment.

Diagnosing menstrual migraine

A headache diary is the most important tool for providing detailed and accurate information about a woman's headaches.

It includes daily information about headaches (severity and duration), medications, menses (or the last day of oral contraceptive) and exposure to triggers. Clinical diagnosis requires a headache diary for at least three consecutive menstrual cycles.

Treating menstrual migraine

Acute treatment

Symptomatic treatment with NSAIDS or triptans is appropriate for people with relatively infrequent, non-disabling headaches and who get reliably good results from the medication, says Dr Loder.

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READERS' COMMENTS

This hurts more than you think
Posted by owwwch, Venice, USA on Tuesday 6 October 2009 at 06:15 UAE time


Migranes brought on by menstruation are shown to be nearly twice as painful as normal migranes, and 9x more painful than a normal headache. Not a joke.





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