Physicians recommend women avoid stacking triggers — for example , combining red wine and chocolate — in the days leading up to their period . Sufferers should also keep a diary of their migraines that includes when the attacks occur in relation to their menstrual cycle . This is particularly useful with menstrual migraines because many women find that by taking proactive measures ( i . e ., ingesting medication before a menstrual migraine starts ), they can head off migraines and / or reduce their severity .
Estrogen drops two to five days before menstruation begins , and that is part of a cascade of events that triggers menstrual migraine . To combat this painful condition , doctors may prescribe mini-prophylaxis or mini-preventive treatments , in which patients begin taking triptans and antiinflammatories two days before their menstrual migraine begins and for the five to seven days after .
“ In many cases , this causes the migraines not to come at all or to be far less intense ,” Dr . Broner says .
Pregnancy , menopause and menstrual migraine
Women who suffer from hormonally triggered migraines often worry about how they will manage their headaches during periods of hormonal change , such as pregnancy and menopause . During pregnancy , when medical treatment options are limited , this is a valid concern , says Susan Broner , MD , of The Headache Institute of New York . “ The first trimester can be difficult ,” Dr . Broner says . Lack of sleep , changes in eating habits and hormonal fluctuations can cause the migraines to temporarily increase . But according to Dr . Broner , studies show that toward the end of the first trimester , more than half of women report improvements in their migraines . By the second trimester , more than 80 percent report improvements that last through the pregnancy .
For women who experience migraines and are planning pregnancy , Dr . Broner suggests implementing lifestyle changes — including regulating sleep patterns and meals , staying hydrated and weaning from caffeine — before getting pregnant .
“ Caffeine can be a great tool to turn off a headache , but only if your body isn ’ t used to a daily dose of it ,” she says . “ Frequent use of caffeine should be avoided as that can cause more headaches .”
In some lucky cases , women report that pregnancy can cause their migraines to essentially disappear , as was the case with Andrea Landau ’ s mother . The younger Landau has suffered from migraines since she was a teen — a trait she inherited from her mother .
“ My mother always had migraines before I was born , but after she was pregnant with me , they pretty much stopped ,” she reports . “ Now she gets them maybe once a year .”
For other women , entering menopause can cause their migraines to stop altogether .
However , during the years leading up to menopause , when the ovaries gradually begin to produce less estrogen and hormone levels tend to fluctuate more widely , migraines can get a great deal worse .
“ Some women who haven ’ t experienced migraines since their 20s find they return with a vengeance during perimenopause ,” Dr . Broner says . “ Perimenopausal women in their 30s and 40s experience a lot of hormone fluctuations along with insomnia , hot flashes and irregular periods . And all of these changes can lead to more frequent migraines .”
This can be a difficult time , but Dr . Broner urges women to remember that for many there is a light at the end of the tunnel .
“ Once the hormone fluctuation stops and menopause begins ,” she says , “ most women tend to see improvements .”
For information on postpartum headaches , go to www . headwisemag . org / OurThoughts / Postpartum . www
28 HEAD WISE | Volume 1 , Issue 3 • 2011