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