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headaches for about 10 years. I suspected the
headaches were worse around or before my menstrual cycle, but my doctor never seemed to see
any association. Eventually he referred me to a
neurologist who diagnosed me with migraine.
My neurologist put me on amitriptyline and
then nadolol, with Amerge® being the “heavy”
drug that I take when an out-of-control headache
is coming on. I recently went off of amitriptyline and nadolol, as it has been three years and I
HEADACHE AFTER
MENOPAUSE
I am a chronic migraine headache sufferer
since the age of 15. I was assured that once I
went through menopause it would all go away.
I have now reached that age, and while they
have reduced, I still have at least one migraine
per week. However, I now experience another
type of headache on a daily basis. This type
of headache does not respond to drugs. The
pressure I feel on my head when lying down for
Amerge when I need it, which is about every two
weeks. It seems someone should have an answer
for me. Eighteen years is a long time.–Susan S.
more than a few hours, no matter what type of
pillow or mattress, gives me a headache. This has
led to restless sleep and reduced performance
at work and even the need to call in sick.
The majority of women who suffer from migraine will
have worse headaches around menses and ovulation,
evidence of a hormonal trigger. Your situation is unusual
because of the onset of migraine at age 37, which is much
later than usual. Migraine attacks are often more frequent
during menopause, presumably because of varying
hormone levels. Sometimes the headaches are better when
taking a low, steady dose of estrogens, but some women
will have worsening of their migraine with taking any
extra estrogen. Remember, however, that the hormone
cycle is just one of many possible triggers.
Taking a daily preventive medication will often reduce
the frequency and severity of attacks, though apparently
amitriptyline and nadolol didn’t do much in your case.
If the headaches are occurring only every two weeks and
you can control them with a triptan, then a daily preventive may not be indicated. Perhaps it would be worth
trying a different triptan other than Amerge to see if you
get more reliable relief.
Robert Kunkel, MD
Emeritus staff
Cleveland Clinic
Cleveland, OH
NHF President
(1994-2005)
A NEW TYPE OF
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HeadW ise™
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Have you ever heard of this? Is this normal
for headache sufferers?–Allison P.
The development of “new” or “different” headaches in
a post-menopausal woman or older gentleman provides
a measure of concern for those of us who specialize in
headaches. The absence of a response to medication also
is a bit disquieting. This presentation is not particularly
compatible for a post-menopausal migraine variant and
should trigger further testing to determine the root cause.
Although these headaches may be merely secondary to
some mechanical compression of nerves in your upper
neck or skull base from degenerative disease–arthritis,
for example–a brain scan and other testing are necessary
to exclude more ominous options. I would advise you
contact your physician with these complaints as soon as
possible.
Robert Kaniecki, MD
Director, The Headache Center
Chief, Headache Division
Assistant Professor of Neurology
University of Pittsburgh
Pittsburgh, PA
HEADACHES AND
Volume 4, Issue 1 • 2014
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6/2/14 8:10 PM