How to prevent menstrual migraines

menstrual migraines

Menstrual migraines affect over 50% of women (1). Of these woman, most will experience migraines during menses but also at other times of the month. Migraines during menses tend to be a little more severe, harder to treat and often reoccur even despite medications. 

Unfortunately, many women have resigned themselves to menstrual migraines because if there is little you can do about your cycle then there is little you can do about your migraines. Right?

Nope.

There a number of options to treat and prevent, yes, prevent menstrual migraines. To understand how and why these treatments can help, it is worth understanding what’s going on during the month.

How the menstrual cycle affects migraines

Women who have a tendency to get menstrual migraines are those who are sensitive to hormonal fluctuations. They are often experienced just prior to the onset of menstruation. Just before menstruation there is a natural drop in progesterone levels.

The two important females hormones involved are progesterone and estrogen.

Progesterone is a natural steroid hormone involved in the female menstrual cycle that stimulates the uterus to prepare for pregnancy. It is a naturally occurring hormone in the female body that helps a woman perform her feminine functions.

Estrogens or oestrogens (American and British English spelling respectively), are a group of compounds which are important in the menstrual and reproductive cycles. They are also naturally occurring steroid hormones in women that promote the development and maintenance of female characteristics of the body.

It is important to note that estrogens are used as part of some oral contraceptives and in estrogen replacement therapy for some postmenopausal women.

Throughout the natural menstrual cycle the levels of these hormones fluctuate. During the cycle, the levels of progesterone and estrogens also change in relation to each other. See the image below for how these levels change throughout the cycle.

This happens as part of being a healthy fertile woman. Those who suffer menstrual migraines may be sensitive to the changes in their estrogen level relative to progesterone.

If this balance is slightly off for what your body requires, then you may have uncomfortable physical symptoms such as PMS, breast tenderness, headaches and, in susceptible women, migraines.

Menstrual cycle

Timing is important for treatment

Timing is important because it can impact how best to treat your menstrual migraines. Below are different hormonal states that may be causing your regular menstrual migraine.

  • If it occurs just prior to the onset of menstruation then it may be due to the natural drop in progesterone levels.
  • Headaches can also occur at ovulation, when estrogen and other hormones peak.
  • Or it may occur during menstruation itself when estrogen and progesterone are at their lowest.

Knowing when your menstrual migraine occurs will determine the best prevention strategy. A good way to determine when your migraines are occurring is by keeping a record of at least 3 cycles to track exactly when your migraines occuried. Remember to note the precise day(s) of your cycle.

Once you have a clear understanding of which days in your menstrual cycle the migraine is occurring, then you are in a good position to begin treating it.

Menstrual migraine treatments

There are many different approaches to help manage menstrual migraine some involve medicinal treatments and others do not. Often it may involve a combination. 

Rest assure that it is possible to reduce and potentially eliminate your menstrual migraines. But it may involve some effort, knowledge and working with a specialist.

Common treatments for those with menstrual migraine include:

  • Dietary changes
  • Lifestyle factors
  • Hormonal Balancing
  • Preventative migraine treatments
  • Acute migraine treatments
  • Natural & homeopathic therapies

If there is an imbalance of estrogen in relation to progesterone then a healthy diet is the first step (in fact it should be one of the first steps for all migraine sufferers). What we eat, plays a huge role in your overall health and wellbeing. 

“Nothing else affects our health more than what we eat.”

- Alexander Mostovoy, H.D., D.H.M.S., B.C.C.T.

If you experience migraines then you diet becomes especially important.  

We hear all the time from the health community something like ‘eat a varied and well balanced diet to help prevent diseases’. But it's been said so many times we kind become  numb to this important advice.

To complicate things, many foods may also act as trigger foods. Finding out which foods trigger migraines can be difficult.

Dietary changes: Why is diet important for menstrual migraines?

Estrogen levels require stricter regulation compared to other hormones in your body to ensure our natural rhythm runs smoothly (2).

Small variances above or below the normal regulated levels can have significant impacts on your health.

The liver metabolizes estrogen. A healthy liver will rapidly metabolize estrogen but if it is overloaded with medications, artificial substances, chemicals or harmful substances from food or drink it can affect the metabolisation of estrogen.

Your diet is thought to be the biggest factor affecting your hormones through the exposure to certain chemicals in food products. Research suggests that diet can attribute up to 90% of all factors affecting your hormones (3).

According to Marcy Holmes, NP, Certified Menopause Clinician

"Compared to other hormones such as progesterone, estrogen levels need to be tightly regulated for the “choreography” to run as smoothly as Mother Nature intended — even small excesses or deficiencies of estrogen can have huge effects on your well-being. A healthy liver metabolizes estrogen rapidly into the more benign of its metabolites. But when it’s bogged down with detoxing medications, environmental chemicals, and harmful substances from food or drink, it can over-metabolize estrogen into its less desirable forms, which can pose a real threat to your health if allowed to accumulate."

Certain food ingredients act like toxins which can disrupt your hormonal balance, so try to reduce or eliminate these altogether. Examples of toxins you may commonly come across include:

  • MSG (monosodium glutamate) - found as a flavor enhancer in many processed foods.
  • Hydrolysed Vegetable Protein
  • Aspartame

Avoid or, if possible, eliminate

If in doubt of what food triggers you may have, it may be worth considering some of the following: 

  • keep a food diary   
  • food allergy test
  • detoxifcation
  • an elimination diet
  • see a certified dietitian or nutritionist

Keeping a food diary is highly recommended. Be careful to include in your diary not just what you eat, but also record other factors which affect your migraines to minimise misattribution of a migraine attack to a particular food or trigger. Uncovering what exactly caused the attack takes time and patience but the process gives you much more control over your condition and is often surprising. 

Food allergy tests unfortunately do not test for specific migraine triggers. But they can be effective at showing what foods your body is reacting abnormally too. Eliminating foods which cause stress or over reactions in the body may improve your migraine frequency or severity.

A detoxification may help cleanse your system of the offending substances but there is little scientific evidence supporting the efficacy of a detoxification. It may simply be a psychological way to push the 'restart' button when beginning a new eating regime.

If you are serious, consulting a certified health care professional like a nutritionist or dietitian to assist you is a good idea. Elimination diets can be tricky to do by yourself and can be dangerous. There is a risk of malnutrition if you don’t know exactly what you’re doing.

To ensure you do this properly seek qualified professional support. That way you will have the best chance of reducing your attacks without starving or being malnourished.

Another simple dietary preventative includes getting enough hydration, especially during menses.

Lifestyle factors

Lifestyle factors like sleep and exercise play a central role in migraine management and sustainable remission.

The right levels of sleep and exercise are VITAL.

Sleep is a restorative function for brain and  body. And it is not just about getting enough sleep each night. It’s about how regular your sleep/wake cycle is. Are you going to bed and waking up at the same time each night? What about on weekends?

It's also about the quality of sleep. The hours of sleep before midnight count more. 9 hours total sleep starting from 10pm is so much better than 10 hours of sleep starting from 1am.

Are you waking up at the same time each morning?

Nobody is perfect, but the better you can get into a consistent routine of high quality sleep, the better for your condition.

Exercise promotes a healthy metabolism, hormonal balance, reduces stress, assists in sleep, stabilizes your mood and gives you an overall sense of well-being.

So just in case you needed another reason, the brain loves exercise. Exercise is great for migraines.

For a few people exercise can trigger migraines. If that's the case, start slowly and build gradually. Be sensible about it. Don't start by trying to run 5 miles. Don't exercise on days when your feeling vulnerable to a migraine attack.

If you exercise outside, wear a hat, keep hydrated and don't let yourself get too hungry.

The evidence for daily exercise is building everyday. Starting small can be a 5 min walk or a short, easy bike ride.

You will feel better for it. When you take care of your body, it is more likely to take care of you.

Hormone Balancing

Hormones can have a significant influence on bodily functions.

But addressing hormones without addressing underlying diet and lifestyle factors is like trying to dry yourself in the shower whilst the water is still running. It will not deliver sustainable results.

To assess hormone levels, blood, saliva and urine testing may be performed to establish a baseline and to identify any hormonal imbalances which may be contributing to migraines.

Thyroid testing is also important as hypothyroidism is not uncommon in migraine sufferers.

For many women, problems appear to arise due to the estrogen dominance and progesterone deficiency. In these cases, bio-identical progesterone in the second half of the female cycle to balance the hormones has shown some success (4).

Another option is to address the falling levels of estrogen which occurs naturally before menses. Estrogen can be topped up in several ways such as via skin patches or gel which is absorbed into the bloodstream. A patch can be applied for 7 days beginning 3 days prior to the first day of menses. Note: if you are trying to get pregnant this is not an appropriate option. 

Other treatments may involve stabilising hormones through the use of the low dose estrogen combination pill which has a constant dose (monophasic). This may be more suitable for those with irregular cycles.

It is a good idea to consult with a healthcare professional who has experience with menstrual migraines and understands female hormones. Look for a certified gynaecologist or endocrinologist who has a track record with migraine patients. 

Preventative menstrual migraine treatments

Preventative treatments can be both medicinal and non medicinal. 

Research suggests that magnesium supplementation for those with menstrual migraines can be beneficial. It has also found that low magnesium levels may be attributed to an lower migraine threshold. Lower migraine thresholds make you more vulnerable to attacks and require less stimulation and fewer triggers to lead to an attack. 

400mg of magnesium everyday can be used as a migraine preventative. Unfortunately there no simple tests for magnesium deficiency as it's the intracellular level of magnesium that we need to improve. The best way to see if it works for you is to try it and ensure that you are absorbing it effectively. 

Medicinal treatments that are generically prescribed to migraine patients regardless of the cause can be used to help reduce the frequency or severity of menstrual migraines. If the migraines are severe or also occur frequently outside of the menses then a migraine preventative may be prescribed. 

When looking at preventative medicinal treatments it is best to discuss these with your doctor who has your full medical history. To read more about the different treatments available click here.

Acute migraine treatments

Often those with menstrual migraine may develop a mini prophylaxis strategy with their doctor where they may take treatments like NSAIDs (non steroidal anti inflammatory) such as iburopofen, Naproxen, Mefenamic acid during the key phase of the cycle to help prevent attacks.

500mg of Naproxen once or twice daily can be effective around the time of menstruation.

Mefenamic acid has been shown to be effective for those with heavy or painful periods. 500mg of mefenamic acid can be taken 3-4 times daily.  

Others may use a low dose of a triptan such as Frovatriptan, Sumatriptan or Naratriptan.

These can be used at the time of menses without significant use of developing medication overuse headaches. NSAIDs and triptans are most likely to be effective as mini-preventative treatments if started 24-48 hours before the expect onset of menstrual migraine.

Natural & homeopathic therapies

Whilst there is less clinical evidence behind the efficacy of natural and homeopathic therapies, they may have less side effects, be safer and offer a natural alternative. 

That said, if they don’t help, you’ve wasted your money.

Do your research before jumping into these kind of treatments to decide if it’s appropriate. Click here to view a more detailed list of alternative therapies.

If you don’t have a well-balanced diet then you may not be getting your required vitamins and minerals. Supplements in this scenario may be useful. Some that have been reported to help migraine sufferers are; Riboflavin, Feverfew, Butterbur, Vitamin B6, Magnesium, Ginger, Coenzyme Q10 (CoQ10) amongst others. 

Ordering the cheapest option from Amazon is not your best option. Vitamins are still considered medication but have far less regulation and quality controls in place. Often it's worth paying extra to ensure quality and safety.

Many vitamins are contra indicated for pregnant woman or woman trying to get pregnant.

Hysterectomy for menstrual migraine?

The short answer is definitely no.

A hysterectomy purely for menstrual migraine is permanent, invasive, unproven and an expensive surgical operation. 

Why it's ineffective for menstrual migraine?

Menstrual migraines are caused by a fall in hormones which is trigged by the ovaries. Whilst menstruation stops with a hysterectomy, it does not stop the ovaries from continuing to trigger monthly hormonal fluctuations.  

There are other ways to non-surgically address the hormonal fluctuations caused by the ovaries. See hormonal treatment above. 

Reducing your menstrual migraines

To summarise: If your migraines are occurring at the same time each month

  1. Keep a diary to inform you and your healthcare professional of exactly when the attacks begin during your cycle. 
  2. Address your diet first
  3. Get enough quality sleep, consistently
  4. Exercise regularly
  5. Stay adequately hydrated, especially during menses
  6. Try magnesium supplementation
  7. Balance your hormones
  8. If severe, consider preventative migraine treatments
  9. Consider NSAIDs or a low dose triptan during menses
  10. Consider natural and homeopathic remedies and other supplements known to help those with migraine.

Often, it is the things we consume or do unknowingly that exacerbate migraine. Identifying and modifying these factors with an improvement to your lifestyle and diet is where you can have the dramatic and sustainable results.

What do you want to try to better manage menstrual migraines? Let me know in the comments below!


 
 

Image Sources

References :

  1. MacGregor E.A., Brandes J., Eikermann A., Giammarco R. (2004) Impact of migraine on patients and their families: the migraine and zolmitriptan evaluation (MAZE) survey-phase III. Curr Med Res Opin 20: 1143–1150
  2. Holmes, M NP, http://www.womenshealthnetwork.com/womenshealth/menstrualmigraines.aspx Accessed Oct 2013.
  3. Fürst P (October 2006). "Dioxins, polychlorinated biphenyls and other organohalogen compounds in human milk. Levels, correlations, trends and exposure through breastfeeding". Mol Nutr Food Res 50 (10): 922–33.
  4. Mostovoy, A. ‘Migraines – Helpful Solutions’ http://www.drmostovoy.com/Migraines.htm. Accessed Oct 15, 2013