Women are three times more likely to have migraines than men. This differential does not begin until the females reach puberty. Sixty per cent of women have migraines related to the menstrual cycle. About fourteen per cent have migraines purely coordinated with menses. Could menstrually related migraines be solely linked to estrogen? That would be like saying migraines are only headaches. We now know migraines are much, much more than headaches. Menstrually related migraines are much more than estrogen fluctuating in the body. Serotonin, prostaglandin, norepinephrine, melatonin, and other chemical levels fluctuate with the menstrual cycle. Each plays some role in menstrual related migraines.
Menstrual migraines usually start between two days before the onset of menses and two days after the onset of menses. A simple option is to take naproxen 500 mg twice a day WITH FOOD during these five days. It is important to take anti-inflammatory medicine with food to help prevent stomach ulcer formation. Do not take if you have a history of ulcers, bleeding problems, or allergy to aspirin. Naproxen will not only help prevent migraines, but it will also help reduce cramping. Certain over-the counter supplements can be helpful.
NEVER take triphasic birth control pills. Even women who do not have menstrual migraines seem to do better on monophasic birth control pills. Oral contraceptives can come in packs with different color pills—twenty one pills of one color and seven of another color. This would be a monophasic pack—either you are on estrogen or you are not. A bi- or triphasic pack would have several different color pills. Every time the color changes, the estrogen dose changes. This is a roller coaster you do not want to be on. The concept of women perpetuating monthly menses must have come from a committee of men. Who wants to have monthly menses? So she can know she is not pregnant? Well, I have a son that disproved that notion. No, women would consider the twenty eight day cycle to be normal is the reason given, and anything different would be perceived as abnormal. I frequently recommend my migraineurs to leave off the placebo pills and just take the oral contraceptives for three months or more. The longer they have been on the pills, the easier the transition occurs. Actually, if a woman wanted to have one menses a year, I would have no objection. Now that oral contraceptives have a very low dose of hormones, it is very important to take the pill approximately the same hour each and every day seven days a week. This lessens the chance of spotting or bleeding. Some women do better with their headaches if they take the pill at night; however, it needs to be the same hour each and every night seven days a week. Bedtime for most people is not the same every night, but they would do better in general. Migraineurs often tolerate birth control pills very well when they are taking a monophasic pill; however, some women cannot tolerate the pill. Smoking is a no-no: especially with migraines! Smoking and taking oral contraceptives is suicidal! The risks of strokes and blood clots are increased. DO NOT SMOKE! For women do not have to be concerned about pregnancy, one possible way to decrease menstrual migraines is to wear an estrogen patch, apply estrogen topically, or take estrogen orally at the time of menses.
Triptans are medicine used to stop migraines. As a general rule, triptans are not used to prevent migraines. Nevertheless, in menstrual migraines, using triptans maybe helpful and are given once or even two or three times a day during the five day window of greatest problems. To find out more, go to http://www.migrainesyndrome.net.