Menstrual Migraines

Migraine headaches are not life threatening but can be so disabling you sometimes feel you are dwelling in a twilight state between life and death. The pain is so crippling you can not participate in your every day life. My first experience with migraine headaches was in high school. An intelligent and talented friend of mine, William, lost days of school at a time due to migraine headache pain. He described how light and noise bothered him - he had to hide the telephone under a pillow while confining himself to a dark room until the pain subsided. I winced at his description of suffering, never dreaming I too would fall prey to this malady - my weak spot. Prepubescent boys and girls experience migraines with the same prevalence. Women, however, are 3 times more likely than men to have migraine headaches.

Menstrually related migraine (MRM) are more severe, last longer and are less responsive to pain medication than other migraine headaches. MRM occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles as well as other times during a woman's cycle. Menstrual migraine (MM) occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles and at no other time of the month. 8% of all women have MRM, but 50% of women who report headaches have MRM (me too). The theory is that falling estrogen levels in the late luteal phase of a woman's cycle trigger migraines.

Treatment of MRM and MM is two pronged - treat the migraine itself once it starts and short-term prevention taken perimenstrually. The April 2008 issue of Neurology published the following recommendations as a result of evidence-based research:

• Perimenstrual short term prevention:
• transcutaneous estrogen 1.5 mg
• frovatriptan 2.5 mg twice daily,
• naratriptan 1 mg twice daily
• Treatment of acute MRM/MM:
• sumatriptan 50 and 100 mg
• mefenamic acid 500 mg
• rizatriptan 10 mg

All recommendations, of course, depend on your clinical situation, but if you suffer from menstrual migraines and are not getting adequate relief, be sure to discuss these findings with your doctor.