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HeadWay, Issue #072 -- A Big Step Forward - Discovering Menstrual Migraine
October 21, 2009

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In this month's issue:

A Big Step Forward - Discovering Menstrual Migraine

News bits from the blog

Say what?!  Pharmacological

A Big Step Forward - Discovering Menstrual Migraine

Perhaps 25% of women have a migraine attack sometime in their life.  But let's go with a lower number, and say 15-20% have migraine disease.  It's estimated that up to 60% of those women experience Menstrually Related Migraine (MRM).

That means there's a very high percentage of the population that has MRM - and an extremely high number of women with migraine who deal with it.  Maybe before we start looking at the many other triggers that are out there, we should look at what may be one of the biggest factors at all for women - the monthly cycle.

First, a note about the role of hormones, specifically estrogen, in migraine.  It's been commonly accepted that hormones play a level in migraine.  However, we also know that a) men also get migraine b) some women do not get migraine attacks related to their menstrual cycles.  Also, recent research has suggested that there may be other reasons, besides hormones, why women are more likely to have migraine than men.  So this is only part of the story.

That being said, it's a big part of the story.  And for women, before looking into the many other factors that go into migraine, it's worth it to take the time to consider Menstrual Migraine, and Menstrually Related Migraine.

Two types...

  • Menstrually Related Migraine (MRM): these attacks of migraine (with no aura) can actually occur any time of the month, but they do seem to be related to your hormonal changes.  66% of the time or more they happen during your period (from day -2 to day +3).
  • Menstrual Migraine (or True/Pure Menstrual Migraine): a migraine without aura in at least 66% of your menstrual cycles during your period (from day -2 to day +3).

Measure it!

It's important to measure for yourself to see if this may be an issue for you.  Take a migraine diary, and use it to keep track of your cycle (pencil it into the boxes where the days of the week are, or use the notes section) and your migraine symptoms.  You especially want to keep track of the 5 days of the perimenstrual period: -2 to +3, with day 1 being the first day of flow.

Now, be sure to especially note the severity of your symptoms, what symptoms you had (especially sensitivity to light), and whether or not you experienced visual aura symptoms (ie seeing flashing lights, zig zags, etc before the onset of pain).

Menstrual Migraine Assessment Tool

Researchers in the USA recently developed what is known as the Menstrual Migraine Assessment Tool (MMAT) to help doctors quickly evaluate if their patients may have Menstrual Migraine.  It consists of three questions.

First, your doctor will want to know if you often have migraine during your perimenstrual period.  If so, she'll want to know if those headaches eventually become severe, and if they cause you to be more bothered by light.  This will give you and your doctor a starting point.

Treating Menstrual Migraine

As with any migraine patient, your treatment will depend on a number of things.  What other conditions do you have, and are you taking other medication?  How severe are your symptoms?  Are you taking supplements?

Menstrual Migraine and MRM can be severe, and a challenge to treat.  But knowing you have it is an excellent starting point.

There are a number of non-drug treatments that have been very helpful, such as biofeedback and relaxation techniques.

Some supplements, such as magnesium and vitamin E may be helpful for some patients.

The triptan drugs have been widely used and promoted for menstrual migraine, particularly eletriptan and frovatriptan.  For women with more frequent and severe attacks, a preventative may be a better option.

There are various types of hormonal therapies that may be tried.  Some are more successful than others, and treatment has been very controversial.  You'll need to carefully research your options.

A hysterectomy is not recommended as a migraine treatment - at times it can even make the migraine attacks worse.

Knowing you have Menstrual Migraine or Menstrually Related Migraine allows you to target many of your attacks in ways you otherwise wouldn't be able to.  You may be able to time the taking of medications, use treatments that tend to be more successful for your condition, or that are more helpful with the symptoms you're more likely to get.  Take the time to check out whether or not this is you.

News bits from the blog

Say what?!  Pharmacological

A pharmacological treatment for headache or migraine is a drug related treatment..  Pharmacology is the science that studies drugs - preparing them, using them, what they're made of and what they do.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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