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Sorting Out My Hormonal/Menstrually Associated Migraines

As the frequency of my migraine episodes has reduced this year, I was finally able to tell that I always get a migraine the first and second or third day of my period. Today once again provided confirmation.

My plan was to try hormonal birth control, like the pill, as a preventive. Researching this post has me reconsidering. Turns out women with migraine who use birth control pills are eight times more likely to have a stroke than women who don’t. This applies to everyone with migraine, not just those with aura (who are twice as likely to have a stroke than migraineurs who don’t have visual auras).

Other treatment options exist. Most of them I’ve already taken without success. Magnesium, which I think is responsible for decreasing the frequency of my migraines, is a common treatment. Unfortunately I’m already at the highest dose of magnesium I appear to be able to tolerate without extreme nausea.

I found on headache specialist Christina Peterson’s website that a small study of black cohosh shows it may be effective in treating menstrually associated migraine. Because there has only been one study, there is no confirmation that it works. Nonetheless, I’ll be researching black cohosh extensively. It is in the same family as rununculus, one of my favorite flowers — maybe that’s a sign it will help my head!

I thought hormonal birth control would be the ticket. A stroke would certainly be worse than having two more migraines a month.

If your migraines are associated with your menstrual cycle, please let me know if you’ve found an effective treatment. Leave a comment below or respond to the forum post with your suggestions.

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18 Responses to Sorting Out My Hormonal/Menstrually Associated Migraines

  1. Kersti Anear says:

    I have menstrual migraines and I have to say that they’re ghastly.

    I’ve also been on the pill since I was 14 because I also suffer from unusually heavy and long periods so without the pill I bleed for 9 days every 28 with 5-6 of those so heavy I cannot leave the house. I also have endometriosis which means that every period is damaging me inside and potentially affecting my fertility.

    I controlled all of these via the pill. I’d simply take it continually without the breaks until I had a break-through bleed. Granted I would often get the headaches regardless every month, but that depended on which pill I took.

    So for me, the problem was when I hit 35 and was told that WHO regulations mean no more oral pill because I get migraines. I was devestated!

    Luckily I found a great specialist who recommended a mirena coil – it’s a very low dose oestrogen only hormone delivered by a plastic coil. No daily pill popping and since I got it no periods at all and no menstrual migraines.

    I would highly recommended it! In fact, I would leap off rooftops to recommend it!

    Another thing, the problem with statistics is that they’re misleading. 8 times more likely… 8 times what? You need to find out what the base-line actually is, and you need to find it out for your own ethnicity, gender, circumstances before you know if this is a problem. If for example the baseline is 10% then 8 times is pretty ghastly, however, if the baseline is 0.01% then you’re still at 8 times 99.92% likely to NOT get one.

    Before you make any decision based on statistics I recommend that you read this article:
    http://www.bbc.co.uk/dna/h2g2/A1091350

  2. Mary says:

    I only get hormonal migraines when I am on birth control pills. The answer for me was to get an IUD. I had a Mirena inserted two months ago and I feel so much better.

  3. becky says:

    I have daily headaches and menstrual migraines. Well, actually mine come for about 3-4 days with my period and then about 3-4 days around ovulation. For me, it’s the dip in estrogen that happens at both those events.

    I did the Nuvaring for awhile, which was great — it has very low dose hormones, so your risk for stroke etc. would be much lower than the conventional BCP. Plus, it’s inserted in your hoo haw, which is a much more effective delivery of hormones than an oral contraceptive, which passes thru your liver (and often loses a lot of its efficacy). You might give that a try!

    As for herbal route, oh yes try that too! I highly recommend finding a reputable naturopath who also does acupuncture. Taht is what I’ve been doing for about 3 years now. It’s how I managed to conceive after 10 years of trying, kept my h/a somewhat under control without drugs during pregnancy, and is how I keep my h/a from destroying my life now. There are tons of herbs, and the best part of naturpathy or eastern medicine is that they are designed just for YOU — they will look at your body and your symptoms and find the best combo. Black cohosh, for example, really makes me miserable. Just 1 day on the stuff and I’m clutching my head in desperation. It didn’t take long for my naturopath and I to realize that anti-estrogenic herbs that often help migraineurs don’t help me! So we work on boosting my adrenals and hormones with other herbs, and that has worked great so far. No, I’m not pain free. I stil have headaches of one kind or another every day of my life. But I’m more in control of my h/a and rarely have the kind that have me in bed or vomitting now.

  4. becky says:

    Oh, and congrats on reducing the frequency of your h/a!!! That is fantastic! I’ve reduced my frequency and intensity, and am now considering this ‘success’. A pain free life is not one I hope to lead.

  5. Julie says:

    I have hormonal and tension headaches with migraine symptoms. They are considered to be “chronic daily headaches”. My head has been hurting at various levels pretty constantly for almost three years now. I don’t get intense migraines that knock me out completely, just constant pain. All of that said, I have decided to use the birth control pills. However, I use it to not only control my hormone levels, but also control the frequency of my period. Using birth control pills, I only get my period once every six months. (Studies show that a woman can go up to year without a period safely.) Additionally, I am on an estrogen patch. (My estrogen level was tested as below normal while on birth control pills….) As a result of both of doing these two things, my headache’s severity has lessened. However, it sounds like our headaches are different. That’s the thing about these headaches….they are so complicated and different for every single person….

  6. Mary Kay says:

    Hi Kerrie,
    First of all I am glad to hear that your headaches are settling down a bit..I remember what it was like to have the horrible hormone headache though..I do recommend the 90 pill to some migraineurs in our clinic but again I work with the patient’s GYN doc as everyone is different..it is a risk/benefit balancing thing.

    I can tell you that most women respond to this and it does work out well for them and their migraines ..stats are very misleading and many times do not apply to clinical practice. I have 40-50 year old patients who were put on the pill for migraine.

    What raises the risk of stroke of migraineurs is the increased frequency of uncontrolled headaches (more than 12 per year) not the fact that you just have migraine.

    Other factors come into play also..family history of stroke, cholesterol levels, does the patient smoke, and believe it or not the NUMBER 1 risk is obesity.

    Good luck..hope it works out for you!
    Mary Kay Betz, MS RPA-C
    Dent Headache Center

  7. I’ve got daily migraine, but they definately get worse around that time of the month. I tried the hormone supplement route, but it only made things worse.

  8. Diana Lee says:

    Once again, we seem to be on a similar step of this journey.

    Just this week I started a birth control for the first time in my life to try to regulate my cycles.

    In the past I’ve always avoided the pill because of my migraines, but I have PCOS and have never had regular periods.

    My doctor and I discussed the stroke risk, and her view was that though mine is increased compared with other women, it is still a low risk.

    I’m taking Yasmin and not skipping a week, so we’ll see how it goes. If it makes my migraines worse, I’ll just stop taking it and reassess things from there.

  9. Anne says:

    A hematologist can check your blood for clotting disorders (i.e, genetic gene variants/mutations).* A recent study linked clotting disorders and those with migraines (You wrote about it and linked to it on Sept. 16). The combo of the pill and a clotting disorder will raise the odds of a blood clot exponentionally.

    *Of course, insurance is unlikely to pay for it.

  10. Robin says:

    For several years I have taken a low-dose birth control pill continuously to stop the dips in my estrogen levels, meaning I don’t take the placebo pills, take the regular pills continuously and never have a period. I used to have severe migraines during the week of my period — those are gone. I also watch my triggers which tend to be chocolate, nuts, MSG, nutrasweet and lack of sleep. I’m on a daily dose of 100 mg of Topamax and take Frova at the first sign of a headache. (more drugs than I would like, but manageable).

    One light at the end of the tunnel — my OB/GYN said she never had a patient past menopause that continued having migraines. I’m hoping that’s true for me!

  11. Christine says:

    All of my migraines went away when I was pregnant, not just the menstrual ones. I felt completely normal. Before that, I had daily mild headache and averaged 6 days of severe migraines every month, most of those days around my period. After my daughter’s birth, I started having depo shots. They do prevent migraines. Obviously, I don’t have menstrual migraines and my other migraines are infrequent and mild. However, I have gained 30lbs on the shot…sigh. I am looking for another solution now. I was thinking I should be a surrogate mom and stay pregnant all the time. I handle pregnancy pretty well…

  12. Christina P says:

    Actually, recent epidemiologic data on women with migraine show that there is independent risk of stroke due to migraine itself. Controlling other risk factors (blood pressure, cholesterol, smoking, weight) does not reduce the portion of risk that is due to migraine itself. While it is strongly suspected that there is a correlation between attack frequency and stroke risk, there is, as yet, no data from randomized controlled prospective trials to show that any specific number of headaches/month or per year is critical, or that any particular treatment is best.

    In addition, it is strongly suspected that there is a subpopulation of migraineurs who are at greater risk of stroke than others (over and above those with aura vs those without) on the basis of “endothelial dysfunction”, which is very likely genetically determined.

    Stay tuned.

  13. Karyn says:

    Since I was 20 or so (I’m now 32) I’ve experienced menstrual migraines. I didn’t realize they were menstrual for years. (I never used tampons because I always was afraid I was getting TSS when a headache would come on!) When I was pregnant last year, a got two minor migraines during the 1st trimester and then none for the rest of the pregnancy. What heaven!!! When I started BC at 3 month post-partum they returned. I think mine are worsened by use of BC – even though their onset is prior to the off week.

    From the posts here, I plan to investigate non-oral BC options that may reduce the migraines. I had no idea that there were other options. I do think mine are aggrevated by BC. Being on and off BC though my early 20s, I think that is why I never realized they were menstrual.

  14. Susan says:

    Hi Kerrie,
    I have suffered with migraines all of my life but they always seem to get worse at the time of me period. I have tried everything but nothing ever seems to work. From hormone supplements to herbal medicines to general medications..I have just tried to live with it the best i can.

  15. I too get sever migraines while on my menstrual cycle but I have found that while I’m on birth control I never get them. Is taking birth control just to avoid migraine headaches safe?

    *********
    No less safe than taking it for birth control. There is a tiny increased risk of stroke in people with migraine with aura: http://www.thedailyheadache.com/2008/11/sorting-out-my-hormonalmenstrually-associated-migraines.html

    Be sure to read the comments on the post — I totally overreacted to the level of risk!

    Kerrie

  16. Scott says:

    Thanks My friend,We are willing to look at this. Here is the sort of details which needs to be given rather than the accidental misinformation that’s in the other blogs. Appreciate your sharing this greatest doc.

  17. Hannah says:

    everyone recommending Mirena beware!!!!!!!!! I was on the pill (cilest) for years and after I had my second child I started to get awful headaches that lasted for days so I stopped taking cilest and tried progesterone only pill which was just as bad. Then my doctor suggested Mirena and it sounded fab! Awful having it fitted and pain for days after . Then I had 8months of hell. I didn’t know it at the time but I was depressed. I have never felt so low in my life so I went to doctor thinking I had pnd in tears! Turns out Mirena can bring on depression even if you have no history of it. It was one of the worst times of my life and within a week of the Mirena being removed I felt better. Strangely my friend also went through the exact same thing unbeknownst to me at the time and my doctor actually explained that I was one of many women who had presented the same symptoms to him while on Mirena . Beware

  18. Marlene says:

    Hi All

    I’m 26 years old, and have monthly migraines.
    My migraines are not just hormonal.
    its is also stress, coffee, missed meals, chedder cheese, certain shampoos and cosmetics, certain cleaining chemicals. i’ve learned to avoid things i know can worsen my migraine situation.
    however, i want to mention MSM Forte, it is a herbal medication, consists of pure sulphate.
    since i have migraines from the age of 6, then 12 then constant at age 16.
    2 to 3 times a month. I tried several things, but the MSM took me from 2 -3 month to 2 YEAR -yes only 2 a year… wonderful is it not?
    but, know i’m married got 2 children (youngest born last month) and i think of trying the Mirena, to make my life better with the awful heavy flow i have.
    I’m back on my MSM pills – which i believe in TOTALLY… but i’m scared that the Mirena worsens my migraines. I’ve read SOOOOO many negative things about it- people who got it 10x worse.

    however – to Kersti
    you are the first person who i read about who praises this Mirena option.
    i’m getting my Mirena tomorrow… i really hope it helps along with my herbal MSM pills.

    i’m also a bit concern about the low sex drive and the depression stories i’ve read above here.
    i guess i should try it – but someone who gets migraines i believe they can confirm with me…. it is a dead on fear to get it, or just to think about the fact that it can get worse 🙁

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