Stop Hormone Headaches


"Every month, I get a severe headache with my period. What's going on?"

You're probably having menstrual migraines, which are triggered by changing levels of estrogen during the menstrual cycle. They tend to occur during the two times of the month when estrogen levels drop: with ovulation and at the start of your period.

Your Brain on Hormones
Migraines are not "just a headache" but a complex disease that can cause a severe, throbbing, often disabling pain--usually on one side of the head. You can also have nausea, light and noise sensitivity, and dizziness.

Migraines were thought to be due solely to blood vessel abnormalities in the brain. But now, scientists think a whole series of electrical and chemical events throw the brain into turmoil. Changing estrogen levels are just the trigger.

Some women only get a migraine with their period--often called "true menstrual migraine"--which includes the 2 to 3 days before the period begins through the fifth day of bleeding.

Other hormonally sensitive women may have them sporadically, with additional attacks around their period. (And while most menstrual migraines occur with drops in estrogen levels, any change can provoke a headache.) But they're all menstrually associated migraines, says Merle Diamond, MD, associate director of the Diamond Headache Clinic in Chicago.

Start Simple
"People with good lifestyles do better with their headaches," says Dr. Diamond. Here's how.

Walk, jog, bike, or swim four or five times a week for 40 minutes. "Exercise significantly reduces the risk of migraine," Dr. Diamond says. It also relieves stress, a known migraine trigger.
Eliminate your food triggers before your periods. The most common triggers are aged cheeses, processed meats with nitrites, chocolate, excessive caffeine, alcohol (especially red wine), pickled and marinated foods, citrus fruits, bananas, onions, aspartame, and MSG.
Stay with a routine. Skipping meals, sleeping late on weekends, or any changes in your usual schedule can lead to a migraine.
Find a daily form of relaxation or stress relief. It could be yoga, meditation, progressive muscle relaxation, or biofeedback. Biofeedback is especially effective, says Dr. Diamond. "It's a meditative technique you do with the aid of a machine, which teaches you how to control the muscle contractions and swelling of blood vessels." With training, you can use it on your own.
Try a magnesium supplement. Specialists recommend 400 to 600 mg of chelated magnesium daily.
Pain Relief Options
Treat a menstrual migraine like any other headache. At the first sign, take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium or other OTC pain relievers: aspirin, acetaminophen, or an aspirin/acetaminophen/caffeine combination. A common mistake people make is to hold off taking medication until the migraine becomes more intense, which makes these meds less effective, says Dr. Diamond.

If your headaches come like clockwork with the start of your period, begin taking a pain reliever 2 days before your period, and continue throughout. Talk to your doctor about not overusing OTCs, which can cause rebound headaches.

If there's a predictable pattern to your menstrual migraines, it may help to bump up your estrogen levels by taking 1 mg of estrogen (17 beta-estradiol) twice a day starting 2 or 3 days prior for 2 or 3 days into your period. For less predictable migraines, a dissolvable form of estrogen placed under the tongue can be used as needed and is very effective in reducing the pain and stopping the headache process.

The latest and best therapy according to headache specialists is a class of migraine medications called triptans. They stop the pain and the headache process (including nausea) within a few hours--if you take them when you first feel a migraine coming on. (Triptans are not for people with heart disease, so talk to your doctor about other options.)

If your migraines occur more than four times a month, the triptans aren't helping, or you can't take them because you have heart disease, you may need daily preventive medication with other types of drugs such as a beta-blocker.

"Dear Diary..."
Keep a headache diary or calendar for 2 months, suggests Merle Diamond, MD, then take it to your doctor. Look for patterns in when they occur and what might trigger them. It'll help you get the right diagnosis and treatment. Here's what to record:

The days you have your period
The day(s) you get a headache (use a different color pen) and how long they last
Anything you think could have set off a headache: skipped meals, certain foods, a bad day at work, or sleep disruptions
The severity of the headache
What medication(s) you took, the dosage, when you took it, and how well it worked
PHOTO (COLOR): Shake that monthly migraine once and for all.

PHOTO (COLOR): Notice anything? Write it down!



By Mary Jane Minkin, MD

with Toby Hanlon, EdD

Mary Jane Minkin, MD, is a board-certified obstetrician-gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and coauthor of What Every Woman Needs to Know about Menopause (Yale University Press, 1996).

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