Dear Dr. KnowYourV,
I really hope you can help me. I have been suffering from migraines since I was 12 years old. I am now 27. I have been to several doctors, including specialists, who have helped me control the symptoms, but nothing seems to keep them from happening month after month. I know the things I have to watch like allergies, getting over-tired or dehydrated, too much chocolate and keeping regular meals so as not to over-stress my system. But no matter what I do it seems that every month with my menstrual cycle a new migraine shows up. This is so horrible for me that I have to lie in bed with the covers over my head to block out smells and light from the rest of the house. I usually wake up with the migraine and feel nauseated. I take my prescribed medication for migraines which helps for a little while, but it always comes back within a few hours. At it’s worst this can last up to 3 days of my cycle, interfering with my job and just everything in my life. There are times I have even worried that I have a brain tumor, but the tests are always negative.
Are there any new treatments or medications I haven’t heard of? Please Dr. Boyd, I hope you can help.
Thanks in advance,
Wow Sandy, I’m sorry to hear about your pain and discomfort, and what a bummer to have to deal with it every month. This is the most common, disabling condition in women that we encounter and menstrual migraines are definitely the most frequent and hardest to treat.
Many women suffering from it feel it is just a “normal” part of the monthly routine. They continue to use the same remedies to help relieve their symptoms that were used by all the women in their family (mom, grandmother or aunts) all of which only provide a little relief. But after awhile, when work is missed month after month and the headaches begin to spill over and interfere with daily life, most will seek help from their doctors.
So what is a migraine? And why do they come with menses and are so much more debilitating than a regular headache? Menstrual migraines are more severe, last longer and are more resistant to treatment than migraines that come at other times. MM (menstrual migraines) are usually characterized by 4 criteria: Severe pain, throbbing, unilateral location and intensifies with activity. At least 2 of these must be present to be categorized as MM.
MM can also include nausea, photophobia (worsening with light) or phonophobia (worsening with sounds). They can last from 4 to 72 hours if untreated. MM are usually disabling because symptoms usually will not improve until you stop what you are doing and lay down and rest.
Migraines can have different triggers, but MM are triggered by the decline in estrogen that occurs at the end of the menstrual cycle just before your period begins. This is why most oral contraceptives do not improve the onset of MM - they are designed with 3 weeks of active pills, then one(1) week of placebo pills. The placebo pills have no active hormone in them, so every month with or without the pill your estrogen falls off just before your period triggering another MM. Some of the newer pills have added some estrogen into the placebo pills to help counteract this drop off and hopefully prevent MM from happening.
MM can be associated with neck stiffness, tension and nausea. The migraine triggers cause over dilation of the blood vessels in the brain which can slow blood flow and bring on the severe pain. Migraine medications are designed to cause vasoconstriction, which relieves the migraine. The exact mechanism of MM with estrogen drop off is not completely understood.
So what should you do to treat this monthly problem? The best way is to talk to your doctor and have the appropriate tests done to make sure that there is no other medical issue that needs treated first. If all tests are normal and you are in good health, many doctors will recommend that sufferers add low dose estrogen during the week their menstrual cycle is due. One special way to treat is to take an extended cycle oral contraceptive that cycles every 3 months and at the beginning of the placebo week add 0.9 - 1.0 mg conjugated estrogens or estradiol. This regime has helped completely eliminate MM in many women. Any other migraines that may occur can easily be treated with any regular migraine medication.
Thank you Sandy for your question, I know it has helped a lot of women today to know there is help. Also, ask your doctor about prescribing medical oxygen if you are sensitive to taking medication. Please follow your doctor’s advice.
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Posted by Know Your V at 6:01 AM