During that time, she recorded information about all of her headaches and periods. When we reviewed the diary, we were able to see a link between her severe headaches and her menstrual cycle. I recommend that all young women with headaches keep a diary for three months as Emily did.
Menstrual migraine is treated the same as other migraines— with nonsteroidal anti-inflammatories( NSAID), triptans or sedatives. If the headache generally lasts more than two days and periods are regular, short-term prevention may be considered. Although the Food and Drug Administration has not approved any treatment for the prevention of menstrual migraine, a number of medications have proven to be effective when taken for two to three days prior to menstruation and for the first two days of menstruation. These include the NSAID naproxen, the longacting triptans Frova ® and Amerge ®, and magnesium supplements. Using oral birth control pills to modify menstrual migraine is generally not recommended as the initial approach.
Migraines that fall around menses are often more severe than those that strike at other times of the month. But here’ s the good news: Because these headaches are predictable, they can be planned for with acute or preventive treatments. Maintaining a healthy lifestyle, adequate hydration, and regular meal and sleep times can help you reduce susceptibility to migraine triggers. HW
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A. DAVID ROTHNER, MD, is Director of the Pediatric / Adolescent Headache Clinic and Chairman Emeritus of Child Neurology at the Cleveland Clinic Foundation in Cleveland.
Download free headache diaries from the NHF website at www. headaches. org.
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