How can menstrual migraine be treated?
There are many ways to treat menstrual or menstrual-related migraine, both with and without hormonal manipulation.
“Absolutely. If you like me to elaborate, there's many ways we treat it. Now let's say you have a woman who has menstrual migraine. You could even out the estrogen with doing continuous low dose birth control pills, and I would recommend monophasic in which the estrogen-progesterone are the same. And a trend these days is to do continuous low dose birth control pills so that a woman doesn't even have to stop and have a period every month. Now that can be huge because you're preventing that drop in estrogen. Now other women could do it with other means of birth control, and if they can't tolerate estrogen, there's the IUD’s. Because the other thing we have to remember, we talk about estrogen, is there are some women who can't take estrogen for health reasons, maybe there's a contraindication. Also for some women, maybe estrogen aggravates their headaches instead of makes it better. So having said that, I think hormones can be a big help, but it's not the total answer.
“So a couple of other things I'd like to mention in treatment. There's been studies shown, if a woman were to start taking an anti-inflammatory, like naproxen, some woman may know that as Aleve, other women it may be ibuprofen. If a woman were to start that several days before her anticipated menstrual migraine, and keep taking that anti-inflammatory until the end of her menses, that can reduce the burden of menstrual migraine. And that's not expensive at all. Another inexpensive way to reduce the burden of menstrual migraine is magnesium. Now magnesium can be done all month long for people that have migraines throughout the month, but if a women just had pure menstrual migraine, there was a study showing if she started taking magnesium at the beginning of the luteal phase which is the second half of the cycle, and took about 400 mg a day, that reduced the burden of migraine. And the nice thing about magnesium and an anti-inflammatory is that's pretty accessible for almost anyone. You don't need a prescription, and so that's pretty exciting.
“And then the other thing to mention is the whole class of triptans. Triptans are migraine specific. They first came out in this country in the early 1990s with sumatriptan, which some may know as Imitrex. We've had an explosion of triptans, but what's exciting is many of them have been studied using them short-term for prevention of menstrual migraine. So what does that mean? If a woman has disabling menstrual migraine, instead of waiting until she has the bad headache, if it's predictable and she knows it's going to be her period, perhaps starting with the triptan a day or two before her anticipated menstrual migraine and taking it until her vulnerable time is done.”
Menstrual and menstrual-related migraine can be treated by controlling the estrogen released each month. For women who can’t tolerate estrogen, studies have shown that taking an anti-inflammatory and/or magnesium can be helpful to some women.
Susan Hutchinson, MD
Author - The Women's Guide to Managing Migraine
Orange County Migraine & Headache Center
Dr. Susan Hutchinson is a headache specialist and board-certified family practice physician. In February 2007, she founded Orange County Migraine & Headache Center, dedicated to serving patients with headache and mood disorders. Although she is not a psychiatrist, she has developed a special interest in treating mood disorders as well as headache. The mood disorders she treats include depression; anxiety; bipolar disorder; ADHD; and panic attacks. Dr. Hutchinson suffers from migraine headaches which gives her an empathy with her patients.
She felt such a calling to help patients with headache and mood disorders that she decided to specialize and devote her career to alleviating the suffering caused by both headaches and mood disorders. She lectures nationally on the subject of headache; has written dozens of articles for medical journals; participated in headache research projects and is very active in numerous professional organizations such as the American Headache Society and the National Headache Foundation.
She is the immediate post-chair of the Women’s Issues section of the American Headache Society after serving in the chair position for 5 years. Dr. Hutchinson is a dynamic and sought-after speaker. She speaks for community groups as well as professional groups. In 2010 she became the President of The Orange County Chapter of the California Academy of Family Physicians.