A
ndrea Landau , a 33-year-old migraine sufferer from
New York City , has been getting migraines since she hit puberty . Over the years , many of her worst migraines have occurred in the days leading up to her period .
“ I used to have to leave work because they were so intense ,” Landau says .
This story is not uncommon . Women are three times more likely to get migraines than men , and more than half of the migraines women suffer are triggered by changes in estrogen levels . In a recent poll of migraine sufferers on the National Headache Foundation ’ s Facebook page , 82 percent of respondents said they are “ much more likely ” to get migraines before , during or immediately after their period than at any other time of the month ( see sidebar below ).
“ Hormone fluctuation is a huge trigger that makes women more vulnerable to migraines ,” says Sheena Aurora , MD , director at Swedish Headache Center in Seattle .
“ The drop in estrogen lowers the pain threshold , enhances nerve excitement and causes nerve inflammation ,” Dr . Broner says . It also impacts levels of serotonin and dopamine . “ Together , it leads to migraines that cause greater functional impairment .”
These migraines commonly occur during menstruation , but also can be triggered by ovulation in the middle of the menstrual cycle when estrogen levels rise slightly and then drop , says Jan Lewis Brandes , MD , director of the Nashville Neuroscience Group at St . Thomas Health Services and assistant clinical professor of neurology at Vanderbilt University .
“ It ’ s not so much the drop itself as it is the fluctuation ,” she says . “ It acts as a primer for the migraine .”
Anatomy of a menstrual migraine
Roughly 75 percent of migraine sufferers are women . Among women with migraines , about 60 percent experience menstrual-related migraines , says Susan Broner , MD , a neurologist and headache specialist at The Headache Institute of New York and assistant clinical professor of neurology at Columbia Presbyterian Hospital . Fluctuations in estrogen are the primary culprit , creating a maelstrom of physiological changes that trigger intense and long-lasting migraines .
Proactive treatments can be effective
Hormonally influenced migraines tend to be more intense and longer lasting than other migraines , Dr . Broner says . To make matters worse , the acute treatments that work for everyday migraines , such as triptans and anti-inflammatories , may not be as effective for hormonally related headaches .
But there is some good news . Because menstrual migraines are often predictable , they can generally be managed with a little advance planning .
Laura Barisonzi
26 HEAD WISE | Volume 1 , Issue 3 • 2011