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