There Are Many Ways To Treat Menstrual Migraine

migraineCINCINNATI—There are many treatment options that can help to prevent or ease the discomfort of menstrual migraine, which makes life miserable for millions of American women, says an expert in headache and migraine at the University of Cincinnati (UC) College of Medicine and UC Health.

“Menstrual migraines represent attacks of migraine that begin two days to three days after menstruation,” says Vincent Martin, MD, professor of medicine in UC’s division of general internal medicine and co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute. “They occur in about 7 percent of the female population and in more than half of women who suffer from migraine. These migraines tend to be much worse than those experienced during other times of the menstrual cycle.”

Menstrual migraine is thought to occur as a result of falling estrogen levels at the time of menstruation and the possible release of chemicals called prostaglandins from a shedding uterus, explains Martin.

Hormonal therapies can be used to treat menstrual migraine. Estrogen patches can prevent the fall of estrogen levels and are used two days before the onset of menstrual migraine and continued for a 10-day period, says Martin. Women taking oral contraceptives can be placed on extended duration oral contraceptives during which they are given the active hormone pills for three months followed by a week of placebo pills. Alternatively, extended duration oral contraceptive pills can be administered continuously without a placebo week, says Martin.

“The key is to prevent falls in estrogen that occur when the active hormones are withdrawn,” says Martin.

Non-hormonal therapies for managing menstrual migraines include daily preventive medications and mini-prophylaxis (short-term therapies only given around the time of menstruation to prevent migraines during menstruation), says Martin.

During mini-prophylaxis, a triptan—a class of drugs used to relieve migraine attacks—is given four to five days around menstruation to prevent or lessen the severity of menstrual migraine, says Martin, adding that it can be given one to two days prior to expected onset of menstrual migraine.

Non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen can also be given prior to and during menstruation to prevent menstrual migraine. Other preventive medications like topiramate can be given daily to prevent menstrual and non-menstrual migraine, says Martin.

“Menstrual migraine gets most of the publicity, but headache is one of many other symptoms that occur as a result of falling hormone levels at the time of menstruation,” says Martin. “Painful menstruation or dysmenorrhea often occurs along with menstrual migraine and can be equally disrupting to the lives of these women. The symptoms of dysmenorrhea include cramping, bloating, back pain, irritability and fatigue. Like menstrual migraine these symptoms can be treated with NSAIDS as they too are triggered by the release of chemicals called prostaglandins at the time of menstruation. To achieve optimal pain relief, one may need to treat both disorders as they can be extremely impactful on a patient.”

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