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What's the treatment for menstrual migraine?

Menstrual migraine is a migraine headache that affects a woman each month between the 2nd day before the start of the menstrual period and the end of menstruation. Menstrual migraine is different from nonmenstrual attacks of migraine, even in the same women, in the regularity of its timing and its greater severity. Compared with other times in the

menstrual cycle, a migraine is more than twice as likely to occur during the first 3 days of menstruation and more than three times as likely to be severe.

Migraine headaches are more common in women and 60-70% of women with migraines report some relationship with their menstrual period. Usually there is an increased frequency before, during and after menses. There is a category of migraine that is called a true menstrual migraine. This is a migraine headache that occurs regularly, each month but only between the 2nd day before the menses and the end of menstruation. Menstrual migraine is thought to occur in about 14% of women.

Levels of female sex hormones, specifically progesterone and estrogen, sharply decline in the late phase of the menstrual cycle, just before the onset of the period. Studies have shown that supplemental estrogen given at the time of the natural monthly decline in these hormones delays the onset of migraine until the estrogen level finally decreases. These findings suggest that estrogen withdrawal may trigger migraine in women who are predisposed to migraine. However, falling estrogen levels alone are probably not the only factor involved in menstrual-associated migraine. The density and sensitivity of receptors in the central nervous system that respond to opiate drugs (morphine, codeine, among others) also changes throughout the menstrual cycle.

It is common for women to pay more attention to headaches around the time of their menstrual periods, failing to report shorter, milder headaches that occur at other times. Sometimes the fatigue, menstrual cramping, and other symptoms of menstruation reduce the tolerance of headache. Treatment for menstrual migraine can be very successful in some patients and more challenging in others, and success depends on an accurate diagnosis. Most common treatment inculdes pharmacotherapies, however, some also rely on nonpharmacologic therapies.

Prophylactic treatment with a triptan for 6 days beginning 2 days before the anticipated start of the menstrual migraine reduces the incidence of migraine by at least a half. The triptans act as agonists for 5-hydroxytryptamine (5-HT) receptors and include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), eletriptan (Relpax), lmotriptan (Axert), and frovatriptan (Frova).

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen sodium, play an important role in the treatment of menstrual migraine because they affect prostaglandins, substances that may cause cramping as well as adding to the headache response. One combination analgesic (acetaminophen, aspirin, and caffeine) also has been reported to be effective in treating migraine associated with menses. 8 NSAIDs and other analgesics may be used as either an acute treatment at headache onset or to prevent migraine if taken regularly staring a few days before the anticipated onset of the headache, and continued through the menstrual period. If the period is regular and the headache occurs in a predictable way, it may be worth trying a scheduled dose of an NSAID.

Triptans (naratriptan, rizatriptan, sumatriptan, zolmitriptan) have been found to be effective in aborting menstrual migraines, as well as controlling the associated nausea and vomiting. Sumatriptan given 2-3 days before and continued for the duration of the expected headache was found to be effective in reducing the frequency and severity of menstrual migraine. Naratriptan used in the same manner has also been found to be effective in preventing menstrual migraine. However, in those cases where breakthrough headaches occurred, they were just as severe as in patients taking placebo. For side effects and precautions of triptans, please read the "What are side effects of triptans" section of this article.

Dihydroergotamine (DHE) can be used as a nasal spray or given intramuscularly or intravenously to abort menstrual migraines. Ergotamine (oral, rectal, or intranasal) and DHE (intranasal, intramuscular, or intravenous) can be used around the time of menstruation (several days before and continued for the duration of the expected headache) to prevent menstrual migraines.

Identifying and avoiding aggravating factors is one way for patients to reduce the frequency or severity of migraine attacks. This approach requires close monitoring of attacks and identifying aggravating factors such as stress, foods such as red wine or coffee, skipping medications, and sleep pattern changes. For some, this requires discipline and lifestyle changes and regular use of a diary. More scrupulous avoidance of known headache triggers may be necessary around the time of the period and less important during the rest of the month. For example, some women may need to be careful about getting enough sleep, eating regular meals and avoiding alcohol prior to the start of menstruation if they know they are more vulnerable to headaches at this time. For many women, regular aerobic exercise can help.

More information on headache

What is a headache? - A headache is a condition of mild to severe pain in the head. Tension headaches and migraine headaches account for 90% for all headaches. Headaches can be single or recurrent in nature.
What types of headaches are there? - A wide range of headache types have been classified in detail by the International Headache Society. Including tension-type headache (TTH), migraine, cluster headache.
What causes headache? - Causes of headaches range from eyestrain to inflammation of the sinus cavities to life-threatening conditions. Most headaches are due to tension, migraine, or a combination of the two.
What're the symptoms of a headache? - Signs and symptoms of a headache involve pain in the head, visual impairment such as blurred vision, nausea and vomiting, hearing impairment, irritability, confusion, malaise.
How're headaches diagnosed? - A physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease that is causing the headache.
What headache remedies are available? - Appropriate treatment for headaches is highly specialized depending on the type of headache, individual response, and any associated health conditions.
What's a cluster headache? - Cluster headaches are rare headaches that occur in groups or clusters. Cluster headaches are frequency associated with drooping eyelids, red, watery eyes, and nasal congestion.
What causes a cluster headache? - The immediate cause of pain is in the trigeminal nerve. Cluster headaches are due to an abnormality in the hypothalamus.
What're the symptoms of a cluster headache? - The primary cluster headache symptom is excruciating one-sided head pain centered behind an eye or near the temple.
How is a cluster headache diagnosed? - Cluster headache symptoms guide the diagnosis. A neurologic examination may help doctor detect physical signs of a cluster headache.
How to cure cluster headache? - Treatment for cluster headaches is composed of induction, maintenance, and symptomatic therapies. Medications to treat cluster headaches are classified as either abortives or prophylactics.
What alternative cluster headache remedies are available? - Since some cluster headaches are triggered by stress, stress reduction techniques, such as yoga, meditation, and regular exercise, may be effective.
What's a migraine headache? - Migraine headache is a primary headache disorder with a genetic basis. Adults with migraine describe episodic attacks with specific features.
What causes a migraine headache? - Migraine headache attack is precipitated when pain-sensing nerve cells in the brain (called nociceptors) release chemicals called neuropeptides.
What're migraine headache triggers? - A wide variety of foods, drugs, environmental cues, and personal events are known to trigger migraine headaches.
What're the symptoms of migraine headaches? - Symptoms of migraine headaches include hallucinations, partial obstruction of the visual field, numbness or tingling, or a feeling of heaviness.
How is a migraine headache diagnosed? - The diagnosis of migraine headache rests solely on what a patient describes to a doctor. A diary can help document headache characteristics.
What's the treatment for migraine headache? - Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for early and mild migraine headache. Other drugs used for acute attacks include meperidine and metoclopramide.
What migraine medications are available? - Several nonprescription drugs and some relatively inexpensive prescription drugs are available for migraine headaches. Tricyclic antidepressants (TCAs may be effective migraine prevention.
How to prevent migraine headaches? - The occurrence of common migraine may be reduced in high-risk people who avoid factors that have been associated with previous migraine.
What alternative migraine treatments are available? - Alternative treatments are aimed at prevention of migraine. Migraine headaches are often linked with food allergies or intolerances.
What is ocular migraine? - Ocular migraine is a term which may have different meanings to different physicians. Ocular migraines usually affect only one eye at a time.
How to relieve menstrual migraine? - Menstrual migraine is a migraine headache that affects a woman each month between the 2nd day before the start of the menstrual period and the end of menstruation.
Migraine headache during pregnancy - Over half of women find that their migraines occur less often in the last few months of pregnancy. About 15 to 20 percent of pregnant women have migraines.
What is tension headache? - Tension headaches are the most common type of headache. The primary cause of the pain is sustained muscle tension. Tension headaches can be episodic or chronic.
What causes tension headache? - Tension headaches are caused by muscle tension around the head and neck. tension headaches seem to be more common in women than in men.
What're the symptoms of tension headache? - A tension-type headache may cause diffuse pressure or tightness. The pain of tension headaches usually is mild (not disabling) and bilateral.
How is tension headache diagnosed? - Most tension-type headaches are diagnosed based on a complete and comprehensive history and physical examination.
What's the treatment for tension headache? - Nonprescription painkillers such as aspirin, acetaminophen or ibuprofen most commonly relieve tension headaches.
How to prevent tension headache? - To prevent tension headaches, many different antidepressants may be effective for individuals with and without depressive symptoms.
What're rebound headaches? - Rebound headaches are those caused by medication taken to relieve regular headaches. Rebound headaches frequently occur daily and can be very painful.
What's analgesic rebound headache? - Analgesic-rebound headaches are caused by successively frequent use of pain relievers, both prescription and over-the-counter medications.
What's ergotamine rebound headache? - Throbbing pain of migraine, in conjunction with escalating doses of ergotamine compounds usually indicates ergotamine rebound headache.
What's a sinus headache? - A sinus headache is a headache that occurs because your sinuses are congested with mucus. Sinus headache pain is due to swelling in the sinus cavities.
What causes a sinus headache? - Sinus headaches can be caused by a sinus infection or allergies. They may become infected with bacteria, a virus, or even fungus.
What're the symptoms of a sinus headache? - Symptoms of a sinus headache include pain or pressure in the forehead or around the eyes and cheek(s), tender skin and tender bones over and under the eyes.
How is a sinus headache diagnosed? -To diagnose sinus headache, the doctor will ask about your symptoms and medical history, and perform a physical exam.
What's the treatment for sinus headache relief? - Treatment of sinus headache is by treating the underlying condition, which may be allergic or infectious, and by nasal vasoconstrictors and analgesic medication.
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