Learn effective ways to treat menstrual migraines and alleviate your symptoms. Discover the best treatment options for menstrual migraines and improve your quality of life.Menstrual migraine is associated with a rapid drop in estrogen, a sex hormone. Its decrease in the body occurs immediately before menstruation, as well as during pregnancy, after childbirth, and perimenopause . In addition to biological causes, estrogen can decrease due to oral contraceptives or drugs used before IVF.
Scientists suggest that prostaglandin may also influence menstrual migraines. This is a hormone-like substance that is involved in inflammation, ovulation, and stimulates uterine contractions. Women with heavy and painful periods have higher levels of prostaglandin .
How is menstrual migraine diagnosed?
To determine whether your migraines are related to low estrogen levels, your doctor may ask :
- Do headaches occur during ovulation and menstruation?
- whether the woman uses combined contraceptives – pills, patches, vaginal rings;
- whether the woman uses other types of contraception and whether this has affected the frequency of migraines.
If a woman has been pregnant, the doctor will clarify how the migraine changed during pregnancy and after childbirth, and whether the patient was treated for infertility.
The doctor may also ask you to keep a diary and mark the dates of headache attacks and menstrual periods. It is better if the observations last at least three months.
How to treat menstrual migraine
If you have migraines, seek help from a doctor. A specialist will study your medical history and select the appropriate therapy. There are three main strategies.
Treatment of acute conditions
Therapy is aimed at eliminating migraine attacks. At the early stage of headaches, doctors recommend taking tablets with triptans: sumatriptan, eletriptan or zolmitriptan. They are combined with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.
In the middle of an attack, it may be difficult to wait for the pills to work, so the doctor may prescribe injections with the same triptans or dihydroergotamine . The drugs can relieve symptoms in as little as 10 minutes. Injections may also be needed if there is vomiting and because of it the pills do not have time to work.
Both triptans and dihydroergotamine are also available as a prescription nasal spray. They work faster than a pill but slower than an injection. Doctors typically recommend them as a replacement for injections or when migraines are accompanied by nausea and vomiting.
Mini preventive treatment
The medications are taken before the onset of menstruation and continue for the first few days. The treatment lasts 5-7 days.
For short-term prevention, the following drugs are used:
- NSAIDs: These are taken twice daily and can help prevent or reduce the severity of an attack and make it more responsive to triptans. For example, naproxen taken twice daily has been shown to be effective in studies. Other NSAIDs , such as ibuprofen, are likely to have similar results.
- Hormones. During menstruation, women receive estrogen in the form of a pill, vaginal gel, or patch. This helps prevent the natural drop in hormone levels that causes menstrual migraines. This option is suitable for those who have regular periods.
- Triptans: These are taken twice daily during menstruation and are thought to reduce or prevent menstrual migraines. However, if a woman still has migraines during the month, triptans should be used with caution to avoid overdose.
The American Migraine Foundation also recommends taking magnesium oxide in the form of a medicine, starting from the 15th day of the menstrual cycle and until the beginning of the next period. But other international clinical guidelines for the treatment of menstrual migraine do not include such advice .
Continuous preventive treatment
The method is suitable for women with irregular periods or for those who have not been helped by mini-prophylaxis.
Patients are advised to take birth control pills without a break for menstruation. Typically, oral contraceptives are taken for 21 days, and then there is a 7-day break, during which there is “withdrawal bleeding.” During this break, estrogen drops, which triggers migraines. Based on this, continuous use of birth control pills may be effective in reducing menstrual migraines.
Hormonal birth control can affect women differently. It is important to tell your doctor about any personal risk factors, such as stroke, heart disease, or a tendency to develop blood clots.