Migraine Headaches in Women Headaches are very common, especially in women, where prevalence of migraine headaches is 3 times higher than those of the men. During childhood, the prevalence of headaches among men and women are relatively similar but after reaching maturity, the body’s hormone system changes. Women will start to produce the hormone “estrogen”, from the ovary. Changes in this hormone are ever-present, lasting until menopause where the hormone will remain at a constant level. Why do we have Migraines during Menstruation? Before a menstruation cycle, sex hormones in the body go through change. Estrogen levels drop rapidly 1-3 days before menstruation (estrogen withdrawal.) Migraine headaches are more prevalent among those whose brains more sensitive to stimulants (genetics) or those who have previously suffered from migraine headaches. Migraine headaches are also more common in the period before menopause (premenopausal) due to significant changes to the sex hormones. Hormone levels are not fixed and may also cause hot flashes at night leading to poor sleep and stimulation of a migraine headache. Symptoms of a Migraine Headache during Menstruation Headaches usually occur 2 days before menstruation and may last until the third day of menstruation. The headaches are often more severe and lasts longer than regular migraines. Usually accompanying the headache are other symptoms such as nausea, vomiting, sensitivity to light-sound- smell increased in some patients who respond poorly to treatment of acute migraine or a more severe recurring headache. Treatment The treatment can be divided into 2 phases:
- Treatment during acute pain is no different from treating a regular migraine. Triptans and non-steroidal anti-inflammatory drugs (NSAIDs) are used but may require a higher dose than normal. Several drugs may need to be taken concurrently in order to assure prompt and appropriate treatment.
- Preventive treatment is recommended for patients with severe symptoms or do not respond to acute pain medication. Two types of preventive drugs can be administered, short-term for pre-menstruation period and long-term to be taken daily. There are various kinds of drugs in this group such as, triptans which are long-acting, non-steroidal anti-inflammatory drugs (NSAIDs) and contraceptive pills. Each of these drugs has different advantages and disadvantages subject to the factors of each patient. Birth control pills or hormone pills containing estrogen must be used with extreme caution, especially for patients whose migraines have warning symptoms (migraine with aura), because birth control pills can increase the risk of cerebral thrombosis as well as venous thrombosis in these patients. Thus, in patients with warning symptoms for migraines or those who have risk factors for cardiovascular disease should be examined and analyzed further by medical professionals before considering the use of birth control pills. Note that during menstruation, the risk of migraines increase by 2 times