Menstrual Migraines: A Pain in the Head - Period

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Published July 22, 2009

| FoxNews.com

Mix throbbing, pulsating pain on one side of the head with nausea and sensitivity to light plus a monthly change in hormones, and many women end up with a recipe for a menstrual migraine.

Of the nearly 30 million people in the U.S. who experience migraine headaches, three out of four are women.

"There are a lot of reasons why women are more affected," said Dr. Brian Grosberg, assistant professor of neurology and director of Inpatient Headache Program at Montefiore Headache Center in New York City. "While the exact reason is unknown, hormonal changes do play into it."

There are two types of menstrual migraines: the pure menstrual migraine and the menstrual-related migraine.

A pure menstrual migraine is defined as a headache that occurs solely around a woman’s menstrual cycle – usually cropping up two days before menstruation and three days after the cycle has started, Grosberg said. These types of headaches affect a small percentage of women: about 14 percent.

When it comes to menstrual-related migraines, these patients not only experience debilitating headaches around their cycle, but at other times of the month as well.

"Menstrual-related migraines are a highly prevalent condition affecting more than 50 percent of female migraine patients," Grosberg told FOXNews.com. "This number represents 12 million women annually."

What’s worse is that women say these types of headaches are longer lasting, are often the worst attacks of the month, and can be the most difficult to treat.

"One of the thoughts of why this occurs is its timing in relation to the menstrual cycle, and they are triggered by falling estrogen levels right before menstruation," he said.

Ninety-percent of Grosberg's patients are women, and he uses both medication and non-medication approaches when treating their menstrual migraines.

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"Every single patient keeps a headache diary," he said. "I want to know the frequency of the headaches… whether they are mild, moderate or severe… and I also want my patients to keep track of their menstrual cycle as well as length of their menses and time in between their menses."

All of this information is essential in finding the right treatment.

"For example, some women report they may get migraines only two out of every three cycles," Grosberg said. "So for women who experience headaches around their menses — and knowing this is predictable — we may end up using preemptive treatment."

Grosberg will start treatment two to three days before the expected menstrual headaches and then vary it several days into the period until the women’s menstrual cycle is over. He uses both non-steroidal inflammatory medications such as Aleve (naproxen sodium) as well as migraine-specific medications known as triptians.

"And in some instances hormonal manipulation may be helpful because a migraine is often induced by falling estrogen levels prior to menses," Grosberg said. “Boosting estrogen levels in small doses starting five days before menses may decrease or prevent severity of the attacks."

Getting back to the "headache diary," Grosberg said another big advantage of patients keeping track of their headaches is that they are able to identify triggers.

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Some people have predictable triggers, while other times it’s a culmination of multiple triggers, including:

— Lack of sleep or in rare instances, too much sleep;

— Missing or delaying a meal;

— Changes in weather, especially hot or cold weather, or changes in the barometric pressure;

— Certain types of food and drinks, such as caffeine, wine, artificial sweeteners, hot dogs and deli meats (which contain nitrates), some cheeses, nuts and sauces.

Whatever the reason is, Grosberg recommended that patients see a neurologist or headache specialist.

"No two people have the same kind of migraine attacks," he said. “It’s not a cookie cutter approach. Each person requires a different treatment plan."

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