Menstrual migraines (MM) are one of the most common disabling conditions in women’s
health as they tend to be more severe, prolonged, and more resistant to
treatment than those that occur at other times. A menstrual migraine is
defined as a migraine headache that has it’s onset within a five
day window, beginning two days before and through the 3rd day of menstruation.
Two of the following criteria need to be met:
- Moderate or severe pain
- One-sided location
- Intensification of headache with activity
Associated symptoms of nausea, sensitivity to sound and light are commonly present.
Pain medication such as ibuprofen (Motrin®) is a good initial intervention.
Migraine treatments such as drugs in the triptan class (eg. Imitrex®)
should next be considered, and can also be given preventatively starting
2 3 days before the next menstrual period.
Because MM coincide with a drop in estrogen it offers hormonal manipulation
as an alternative approach. Cyclic regimes of oral contraceptives have
a significant drop in estrogen from the active to the placebo pills that
must be mitigated. One strategy is to use low dose pills and then supplement
with small amounts of estrogen during the pill free interval. Mircette®
is a birth control pill that conveniently incorporates such a regime.
Incidentally, there is no evidence that progesterone only contraceptives
(AKA the mini pill) minimize MM.
Better are regiments that forego monthly withdrawal bleeds by providing
extended administration of active pills, which can afford migraine sufferers
a lengthy reprieve from headaches. Unscheduled bleeding is the most common
side effect that decreases over time. A good example is Lo Seasonique®
birth-control pills which utilize estrogen instead of placebo pills every
13th week when a light menstrual period occurs.
So don’t suffer in silence or miss out on your regular activities
when menstrual headaches occur, come see your gynecologist here at Women’s
Health Specialists and ask for help.