Menstrual migraine is a fairly common problem in women of reproductive age (found in 58% of all fixed cases), which occurs due to hormonal imbalances or the adverse effects of existing factors during the course of the premenstrual period. It is characterized by an attack of a strong and prolonged headache, which is severely relieved by painkillers. With frequent migraines, worsening the normal life of a woman, you should contact a medical specialist who will tell you how to treat migraines in menstruation.
Migraine before menstruation may occur as a result of the expansion of blood vessels in the brain and simultaneous venous stagnation. Such processes provoke a change in the level of estrogen and progesterone (female sex hormones) in the body.
Also the cause of headaches before menstruation may be inappropriate intake of oral contraceptives, containing a high amount of estrogen. This usually happens if a woman prescribes pills for herself without first consulting with her gynecologist. In such cases, in order to get rid of unpleasant symptoms, you just have to opt for taking contraceptive drugs, which contain the minimum amount of the hormonal element - estrogen or it is absent altogether.
The impact of unnatural hormone levels on a woman’s body is not fully understood, but it is believed that the imbalance of these elements contributes to a change in brain activity. Such changes affect the enhanced perception of pain.
Almost every girl who has reached child-bearing age, the word PMS (premenstrual syndrome) is known. This is a set of unpleasant symptoms that are closely associated with the menstrual cycle and occur immediately before the onset of the regul (2-5 days). In the premenstrual period there is a change in hormone levels, water-salt balance and blood composition. This provokes the appearance of signs of PMS (intense bouts of headache, weakness, drowsiness, increased sweating, pain in the lower abdomen, etc.).
Regardless of whether a migraine occurs after menstruation, before, or during, it is recommended to go to the hospital if it is systematic.
Migraine with menstruation can trigger the following factors:
- Abuse of alcoholic beverages,
- Tobacco smoking
- The systematic use of beverages containing caffeine,
- Psycho-emotional disorders (frequent stress, depression),
- Constant lack of sleep
- Work at an unsafe enterprise (work with chemical elements or various types of radiation),
- Frequent consumption of foods that contain large amounts of tiramin (meat, smoked fish, bananas, chocolate, dried fruit),
- Constant malnutrition, frequent diets.
Every woman should be aware of what is a migraine, what is dangerous about its appearance, and what are the ways of her therapy. To do this, you need to figure out how it differs from an ordinary headache. First of all, migraine is accompanied by strong, pulsating tingles in the head, which are often localized on one side only.
30 minutes before the onset of an attack, the following symptoms may occur:
- Numbness or tingling in the fingers and face,
- Unnatural enhanced reaction of the eyes to light
- Inability to think normally,
- Aversion from the usual smell, changes in taste, unnatural sensations when tactile contact with any object.
Migraine attacks can also be accompanied by:
- Bouts of nausea, vomiting,
- A short loss of vision or darkening in the eyes,
- Intense pains in the temples, behind the sockets, in the area of the ear lobes.
In the most severe cases, a short-term loss of consciousness is possible.
There is no definite diagnostic pattern. In order to determine whether the migraine attacks associated with the menstrual cycle are connected, the doctor suggests that the patient should keep a diary for three months. In it, the girl should mark the beginning of each menstrual phase and the menstruation itself, as well as date the appearance of headaches that occur on critical and ordinary days. After this observation, the treating doctor will be able to determine whether migraine attacks are associated with menstruation, and will also prescribe the necessary treatment methods.
Migraine in menopause and during pregnancy
The occurrence of headaches of an intense nature can be observed not only during menstruation. Also, often girls carrying a child complain about the appearance of such a pathology. It is also associated with increased levels of estrogen in their bodies. Usually, such hormonal changes occur in the first three months of pregnancy. Starting from the 4-5th month, the hormone levels stabilize, and migraine attacks begin to gradually disappear. But in rare cases, pain worries the girl throughout the entire period of gestation, which causes her to look for any ways to eliminate it. It is not recommended to take self-selected painkillers, as they may adversely affect the health of the fetus and directly on the condition of the woman. The appointment of a symptomatic drug must be given to the attending physician, who will take into account all the existing nuances of this provision.
Often there is a headache during menopause (extinction of reproductive function, the termination of the synthesis of sex hormones, the gradual cessation of menstruation). This also happens because of hormonal surges — with normal ovarian function, the amount of hormones produced decreases, which causes them to work at an accelerated rate. The lack of estrogen is accompanied by a change in brain activity and the appearance of strong pain in the head. After menopause (the doctor diagnoses it 12 months after the last menstrual period), the unpleasant symptoms of menopause (including migraines) disappear on their own. Sometimes medication may be prescribed to restore the level of hormonal elements and eliminate unpleasant symptoms.
If the diagnosis is confirmed and worries a woman 1-2 times a month, then a qualified physician prescribes the treatment of menstrual migraine with NSAIDs (nonsteroidal anti-inflammatory drugs) or triptans.
NSAIDs are the main type of therapy that helps to get rid of unpleasant symptoms that appear before menstruation or during menstruation. To do this, you can use the following drugs:
Also often prescribed use of pharmacological agents - Syncapton. It contains elements of caffeine, ergotamine and dimenhydrinate, which help relieve spasms, restore arterial tone and have a calming effect.
If nonsteroidal anti-inflammatory drugs do not bring a positive result, or intense headaches disturb a woman often and for a long time, the medical specialist prescribes medications that are in the group of triptans.
The following drugs can quickly prevent a migraine attack:
The above means contribute to the removal of headaches within 30 min-2 hours after consumption. However, it’s not worthwhile to start taking such medications yourself. Many of them have a lot of contraindications and side effects. The purpose of these drugs must be given to your doctor.
The most frequent side effects after taking the medication of the triptans group:
- Feelings of weakness, dizziness, hot flashes, and increased sleepiness,
- The urge to vomit and nausea,
- Pain and weakness in the muscles
- Frequent urging to the toilet,
- Pain in the chest and abdomen.
Children under 18, elderly women and pregnant women suffering from migraine attacks are strictly forbidden to take the above drugs without the knowledge of a knowledgeable doctor. Be sure to consult with a medical specialist who will explain whether you can take triptans in your situation or not, as well as familiarize you with the basic recommendations that will prevent headaches in the future.
If migraine attacks are rare, they are not too intense, the woman is forbidden to take artificial medications or there are other reasons why using triptans, painkillers or NSAIDs is not possible, then the doctor may recommend using “grandmother's” methods that also effectively deal with headaches :
- Aromatic oil of lavender - perhaps inhalation or external use. For the exterior: a small amount of oil is applied to the temporal region and rubbed in a circular motion. Inhalation: 3-5 drops of aroma oil dissolve in 0.5 l. boiled water. Inhale fumes for 7-10 min.,
- Peppermint - perfectly and quickly stabilizes the state of the vascular walls in the brain. You can use it by rubbing it in your temples, inhaling the inhaler mixture and in the form of tea or infusion,
- Fish fat. A great way to get rid of unpleasant symptoms that occur at the time of menstruation, is the reception of fish oil. You need to use it one teaspoon per day or 2 compressed capsules (as such, you can buy it at the pharmacy),
- Ginger - stops inflammation, eliminates pain and bouts of nausea. Ginger root in a crushed form is used for brewing tea (1 tsp. Per cup) or for making decoction (4 tbsp. Per half liter of water). It is recommended to drink tea or decoction at least 3 times a day.
In addition to popular recipes, drinking plenty of fluids is considered one of the most effective ways to cope with migraines. If a girl will consume at least 1.5 liters per day. water (pure), the symptoms of menstruation will never disturb her.
Causes of Menstrual Migraine
As already mentioned, menstrual headache may be hormonal in nature, but also it may not be associated with hormones.
These symptoms are characteristic of the first menstruation, and in the future they, as a rule, do not appear.
But women with a steady cycle may suffer from menstrual migraine. The reason for this is a hormonal imbalance. After the egg comes out of the follicle in its place a corpus lute forms, which produces progesterone, the pregnancy hormone.
In the event that fertilization does not occur, the egg cell dies, the corpus luteum undergoes transformation, the uterine mucosa begins to be torn away. At this moment a hormonal jump occurs. The level of progesterone drops sharply, there is a large release of estrogen, which is responsible for the formation of the follicle and the maturation of the new egg. This restructuring of the body and causes headaches.
- Non-hormonal causes of menstrual migraine:
- chronic fatigue,
- psycho-emotional stress, stress,
- hormonal drugs,
- fluid accumulation in the body
- diseases of the cardiovascular system
- allergic diseases.
- How does hormone medication affect migraines? Hormonal contraception provokes a migraine in the event that the drug is chosen correctly. The body reacts to this either in the first days of taking contraceptives, or during the first month.
- Migraine associated with fluid accumulation in the body. The retention of fluid in the female body provokes the use of many different drinks and salty foods - from her internal organs begin to swell. The brain is not an exception: it grows in size, squeezes blood vessels - and this leads to oxygen starvation and severe headaches.
- Migraine and diseases of the cardiovascular system. A sharp drop in pressure, uterine spasm and uterine bleeding can cause a headache. If the cardiovascular system of a woman is normal, then she may not react to these factors, but if there is a pathology, then the pain will definitely begin.
There is a true menstrual migraine - meets the criteria for migraine without aura, occurs on the 1st, 2nd day of menstruation, up to 3 days, and does not occur on other days of the cycle, and migraine associated with menstruation is a migraine without aura, which occurs in the first 3 days of menstruation, as well as on any other days of the cycle.
Now you are aware of the causes of migraine before, during and after your period, during ovulation.
Migraine can occur both before the onset of menstruation, and during the first days of flow, as well as within 2 to 3 days after menstruation. Most seizures associated with menstruation is a migraine without aura.
- headache (in the temporal or frontal part),
- sudden mood swings
- loss of appetite,
- physical weakness, fatigue,
- decrease in mental activity, absent-mindedness,
- increased reaction to external stimuli (on harsh odors, bright lighting, loud music),
- violation of visual functions (loss of visual clarity),
- blood pressure fluctuations
- nausea that develops into vomiting,
- pale skin
- difficulty sleeping
What to do to prevent migraines before menstruation? It is necessary to take medications prescribed by a gynecologist in a timely manner, as well as to follow the daily regimen and diet. For the treatment used drugs of different groups, the combination of which is selected for each patient individually.
Most often, before menstruation, nonsteroidal anti-inflammatory drugs and analgesics are recommended - ibuprofen, paracetamol, diclofenac, and others. A new approach to the prevention of migraine attacks is the appointment of antiepileptic drugs, the effectiveness of which is explained by similar mechanisms of development of migraine attacks and seizures (for example, Topiramate (Topamax)).
In addition, during the premenstrual period, it is recommended:
limit salty, smoked and fatty foods in the diet,
- exclude carbonated drinks
- reduce physical exertion
- sleep in a well ventilated area.
- take too hot baths
- be in the open sunshine
- to visit the sauna.
To reduce the painful sensation during premenstrual migraine it is helpful to drink in moderate amounts sweet green tea and coffee.
How to treat migraine during menstruation? To eliminate migraine drugs are used from different groups:
- Nonsteroidal anti-inflammatory drugs and analgesics - the main method of therapy:
- acetylsalicylic acid,
These medicines will not only reduce the intensity of pain in the head, but also relieve menstrual pain in the lower abdomen.
For the choice of a suitable medicine it is best to consult with a specialist.
Additional ways to relieve menstrual migraine:
apply ice packs or cold compresses on the pain area,
- to deal with stress and stress by applying yoga, massage, breathing exercises and stretching,
- be treated with acupuncture,
- observe the mode of work and sleep, do not drink alcohol, do not smoke.
Headaches during ovulation are also not uncommon. They can be due to both natural sensitivity and various pathologies. Compliance with the following recommendations will help reduce the likelihood of headaches during the ovulation period:
- Compliance with the rules of healthy eating.
- Getting rid of bad habits.
- Mode of moderate physical activity.
- Reception of vitamin complexes.
To relieve migraines during ovulation, you can use:
- Conventional painkillers:
- Specific anti-migraine drugs:
Menstrual migraine is an extremely unpleasant phenomenon. During the period of menstruation, the body is already in its most vulnerable form, and here is added a strong headache. Therefore, it is extremely important to notice the onset of malaise in time and take appropriate measures, as well as not to forget about the prevention of menstrual migraines, if they have been observed before. Now you know what constitutes this affliction.
The causes of the disease
First of all, it is worth noting that migraines can occur during different periods of the menstrual cycle: before, after and during menstruation. The interdependence of the menstrual cycle and migraine is established only by the age of 35. If the migraine before menstruation and after menstruation occurs paroxysmally and the patient may well tolerate pain, then the migraine in menstruation can be extremely severe and be observed throughout the cycle. Unfortunately, migraine during menstruation is fairly resistant to analgesics, and it is extremely difficult to cope with this symptom.If the reason for the occurrence of such a pathology are endocrine disorders, the disease is very poorly amenable to any treatment.
To understand what to do and how to act at the first manifestations of a migraine, it is first necessary to determine what its source is. Menstrual migraine occurs most often due to increased levels of prostaglandins in the patient's body. In turn, this causes a decrease in the synthesis of estrogen and progesterone. These substances cease to suppress the increased excitability of the cerebral cortex, and the mechanism of migraine is triggered. In addition, extradiol, an ovarian hormone that affects neuron excitability, can have a significant effect. Body systems remain unprotected from other influencing factors. As a result, a migraine appears during menstruation. These factors include:
- accumulation of fluid in the body of a woman
- a sharp rise and fall in blood pressure levels,
- excessive fatigue
- prolonged stress,
- a treatment consisting of drugs with a hormonal basis,
- hypersensitivity to estrogen.
Worst of all, the situation is during the reorganization of the woman's body when entering the reproductive age. That is why the period of unpleasant and painful sensations falls on the first menstrual periods. In order to correctly draw up a course of treatment, you must first diagnose the appearance of a disorder such as menstrual migraine, and the symptoms of pathology can help.
Symptoms of the disease
The first signs of migraine pain occur in the luteal stage of the menstrual cycle.
This phase begins two weeks before the first menstrual period. In a woman's body, cells are formed that synthesize progesterone and estrogen. If fertilization does not occur, then the production of hormones is reduced, and the body again begins to accumulate resources. It is for this reason that migraine attacks intensify as the menstruation approaches and completely disappear after its completion. This violation has characteristic features:
- pain is localized in the temples and forehead,
- sensations have a long and pulsating character,
- a woman has an increased sensitivity to smells and loud sounds,
- intraocular pressure occurs and there is a loss of sharpness of vision,
- frequent drops in arterial and venous pressure occur,
- memory disturbance occurs, absent-mindedness appears,
- aching pain occurs in the heart, sometimes there is a failure in the heart rhythm,
- nausea, possibly vomiting, lack of appetite,
- fatigue, sometimes insomnia,
- bouts of aggression, irritability, irascibility,
- the woman looks pale, sweats heavily.
In addition to these signs, it can be noted such manifestations as delay. To cope with the pain syndrome, women begin taking analgesics and antispasmodics. Unfortunately, this is a common mistake, because menstrual migraine is not affected by such drugs and as a result, the patient continues to be in pain. If such a deviation is observed regularly, you should, without delay, visit a neurologist who can prescribe the correct treatment and adjust the patient's lifestyle.
Disease treatment order
Having learned what menstrual migraine is, one can consider issues related to the treatment of this pathology. The effectiveness of therapy depends largely on the root cause of the onset of pain, as well as on which type of deviation takes place - a migraine after menstruation, during a cycle or before the onset of the phase.
During the first visit to the doctor, the patient is prescribed medications that assist with normal migraine, and the specialist instructs the girl to fix migraine attacks and periods of menstruation. The diary is kept for three months, after which the specialist diagnoses the disease and develops a special course of treatment of pathology. There are two treatment directions in this case:
- relief of attacks,
- preventive measures to prevent the occurrence of migraine attacks.
Both methods involve the administration of special drugs:
What is it like?
Menstrual migraine most often implies its “true form”, which is manifested by a migraine attack “without aura” during the so-called “5-day window”: the last two days that precede the onset of menstruation and the first three days of the menstrual cycle. ICD-10 code: G43.0.
The following subspecies of menstrual migraine can be distinguished clinically:
- "Pure" / "true" form, which is characterized by the occurrence of attacks only in the perimenstrual period,
- menstrual associated form migraine, which is characterized by the occurrence of attacks not only in the perimenstrual period, but also in another phase of the menstrual cycle.
Menstrual differs from other forms of migraine by the following characteristics:
- longer and more severe attacks,
- higher intensity of headache
- relatively high tendency to relapse
- more difficult to treat,
- more lead to maladjustment.
Causes of illness before, during and after menstruation
The undulating changes in the level of estrogen in the perimenstrual period is a fundamental pathogenetic link in the development of menstrual migraine. Using oral contraceptives can change the frequency and severity of its course..
Reducing the dose of estrogen, changing the route of administration of hormone replacement therapy (oral to transdermal) can reduce the intensity of the headache.
Gynecological diseases such as: endometriosis, ovarian dysfunction, premenstrual syndrome, infertility, also aggravate the course of menstrual migraine, as evidenced by statistical data.
In most cases, migraine acquires a favorable course in the last 2 trimesters of pregnancy, and its course may worsen in the postpartum period. The incidence of seizures also decreases with age, and they become lighter in many postmenopausal women..
Mechanism of occurrence
The key point in the study of the pathogenetic mechanisms of menstrual migraine is the study of the influence of hormone fluctuations on the functional state of the brain.
Estrogens are capable of changing the activity and excitability of neurons by acting on the corresponding receptors diffusely located in different parts of the brain, mainly in the hypothalamus, thalamus and adjacent structures that regulate emotional behavior, the development of anxiety and fear.
During the menstrual cycle, wavy oscillations of sex hormones occur, which affects neuronal excitability. The excitability of the structures of the nervous system increases during peak estrogen levels during the perimenstrual period, which causes an increased risk of an attack.
The clinic of menstrual migraine is represented by the classic symptoms of migraine “without aura”. It is characterized by regular bouts of headache, lasting from 4 hours to 3 days.
For the pain is characteristic: one-sided localization, pulsating nature, medium or high intensity, often accompanied by an attack: nausea or vomiting, increased sensitivity to light and / or sound stimuli.
A distinctive feature is considered to be the obvious pattern of dependence of exacerbations on the phase of the menstrual cycle.
Possible complications and consequences
By itself, menstrual migraine can lead to severe maladjustment of patients, causing prolonged disability, physical or emotional exhaustion.
Most of the risks and possible complications are associated with medication, in particular hormone therapy.
There are numerous studies aimed at studying the relationship between migraine and stroke.. Taking oral contraceptives in the presence of migraine can greatly increase the risk of ischemic stroke, cardiovascular disease, but in fact, it is more typical of the form with "aura".
There are a number of non-pharmacological methods of treatment, which should be strictly coordinated with your doctor:
Treatment consists of symptomatic treatment of the acute period of a migraine attack.
Factors determining the effectiveness of treatment:
- correct selection of drugs in adequate doses,
- appropriate treatment of associated symptoms: nausea / vomiting,
- taking drugs at the stage of low pain, and not at its peak,
- multiple reception for several consecutive days. However, the use of codeine-containing analgesics, ergotamine preparations or triptans should be limited to a maximum of 10 days per month, simple analgesics can only be used for 15 days.
Triptans and NSAIDs
Due to the greater duration and severity of the flow, first line drugs are triptans. Effective in this regard: Sumatriptan 50 and 100 mg, Rizatriptan 10 mg, Zolmitriptan.
The following drugs have also proven their effectiveness:
- mefenamic acid 0.5 g,
- combination: naproxen 500 mg + sumatriptan 85 mg.
Combined hormonal contraceptives
- Continuously, without an "interval without hormones." In this mode, there is no fluctuation in the level of estrogen, thus ensuring the safe and effective elimination of symptoms of an attack. Among the shortcomings can be identified: irregular bleeding, induction of amenorrhea in 80-100% of women at 10-12 months of treatment. Contraindicated in migraines with "aura" due to the high risk of stroke.
- With an "interval without hormones." This option mode allows you to save monthly menstruation, but the benefits in this case is limited.
Have a good effect, in particular, inhibiting ovulation and provoking amenorrhea with prolonged use.
Used: Depot-Medroxyprogesterone Acetate, subcutaneous or oral etonorgestrel. Oral forms have a weaker effect.
It is important to warn women who use hormone therapy to take the medication until they reach amenorrhea. Often, these medications are stopped due to irregular bleeding in the first months of administration.
There are the following ways to prevent menstrual migraine attacks:
- long-term (similar to prophylactic measures for classical forms of migraine),
- short-term (held 2-3 days before the onset of menstruation, with medication intake for 5-7 days).
None of the drugs listed below is licensed as a prophylactic agent, but in a number of clinical studies they have shown their effectiveness.
For the purpose of prevention are used:
- Naproxen, 550 mg 1- 2 times a day during the perimenstrual period, between days -7 and +6,
- Mefenamic acid, 500 mg, 3-4 times a day. It is taken two or three days before the expected onset of menstruation, for another five days.
The advantage of using NSAIDs is their effectiveness even when taking on the first day of bleeding, which is important for women with dysmenorrhea.
- Naratriptan: 1 mg twice a day, starting two days before menstruation, continuing for six days,
- Frovatriptan is taken in a dose of 5 mg twice a day, starting 2 days before the expected attack, and then the dose is halved with a double intake for another 5 days,
- Zolmitriptan, 2.5 mg 1 tablet 3 times a day. Approximately 55-60% of cases helps to reduce the frequency and severity of attacks in half or more in 3 consecutive cycles. Of the side effects, there may be a “drug withdrawal” effect with a relapse.
Perimenstrually estrogen can be used only under the condition of regular menstruation. Not recommended for women with dysmenorrhea, estrogen-dependent tumors, or a history of venous thromboembolism.
- adverse effects of estrogen deficiency, such as hot flashes,
- decrease in bone density (usually should not be used for more than 6 months without regular monitoring and bone densitometry),
- high price.
Given these characteristics, the use of such drugs should be limited to specialized units.
Due to the fact that the most effective method for the prevention and treatment of menstrual migraine is not determined, an empirical selection is necessary first, followed by an individual approach to each patient taking into account all the features: duration and severity of the attack, regular menstrual cycle, the presence of dysmenorrhea or other concomitant diseases.
It is advisable that hormone therapy be prescribed and monitored by a gynecologist, and anti-migraine therapy by a neurologist, which can be considered the “gold standard” for the treatment of menstrual migraine.
You can learn more about menstrual migraine from this video: