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Managing Your Period to Manage Migraine

Lybrel, a continuous birth control pill that stops menstruation recently approved by the FDA, may help prevent menstrually associated migraines for some women. Hormonal birth control is often used as a migraine preventive. Many doctors prescribe that patients replace the sugar pills with active pills to suppress menstruation, thus lessening hormonal fluctuations.

Taken each day, Lybrel provides a continuous supply of hormones without a break for a period, ever. It seems creepy to me, but The Well-Timed Period quotes a report that says that periods aren’t as necessary as they seem. Also, I’m one of the few women who actually likes having a period. (Maybe you didn’t want to know that?)

Learn more about “menstrual management” under “How to Skip a Period” on The Well-Timed Period and pokearound the informative blog.

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Estrogen Withdrawal is a Migraine Trigger

The long-standing hypothesis that when estrogen levels drop right before and during a woman’s period, it triggers migraines has been supported in a recent study. The study also found a connection between increased estrogen levels and decreased migraine frequency. (It’s a Medscape article; go to BugMeNot for a password.)

In a second study, the same participants — all of whom had previously been diagnosed with menstrual migraine — had a reduction in migraine days when they received supplemental estrogen (via estradiol gel) before their periods.

Interestingly, if the supplemental estrogen was stopped too soon, the women’s estrogen withdrawal still happened, just later in their cycles. Researchers say that if the doses of supplemental estrogen were extended by a few days, withdrawal (thus migraines) could be avoided altogether.

These results appeared in the December 26 issue of Neurology; here’s the abstract. I got my information from the Medscape article, which I recommend reading — it’s one step closer to the source and less simplistic than my summary.

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Headaches, Hormones & Breastfeeding: Purely Anecdotal But Interesting

I saw a new OB/GYN last week (and loved her). Not surprisingly, we talked about headaches and hormones. Turns out she has frequent headaches too, which she thinks are hormonal.

When I asked how they were when she was pregnant, she said that they were better during her pregnancy and while she was breastfeeding. When her milk production slowed down and she began to wean her son, she had a two-week long headache. During this time, of course, her hormone levels were changing. She also said that her friend had the same experience. This is anecdotal of course, but it’s food for thought.

I don’t have any firsthand knowledge of what hormonal headaches are about (I flirted with the idea that mine are menstrual, but am sure they aren’t), but some resources include American Council for Headache Education, the National Headache Foundation and the National Women’s Health Information Center. I found this last resource to be most helpful.

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Migraine and Estrogen Officially Linked

A review of 643 unique journal articles related to estrogen and migraine establishes that the two are indeed linked. My initial reaction to this was “duh,” but stating the fact so plainly helps legitimize further clinical research on the topic.

The article concludes:

Epidemiological, pathophysiological, and clinical evidence link estrogen to migraine headaches. Triptans appear to provide acute relief and also may be useful for headache prevention. Clear, focused, and evidence-based treatment algorithms are needed to support primary care physicians, neurologists, and gynecologists in the treatment of this common condition.

In possibly related news, a study published in an oral surgery journal states that “the affective component of pain my be enhanced during the low-estrogen phase of the menstrual cycle in healthy women.” That is, women are more sensitive to pain from oral surgery when their estrogen is low. Perhaps the link isn’t only migraine-specific, but pain in general.

There’s tons of information available if you want to learn more about estrogen or menstruation and migraine. I recommend ACHE’s women and migraine section and their related newsletter articles (look under headache sufferer subgroups, then under women), and the National Women’s Health Information Center’s migraine section.

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Misery and Maybe Menstrual Migraines

“I’m about to get out of the bathtub, but I’m not sure if I can stand up. If I can I’ll come pick you up. Let me call you back in a couple minutes.” That was my end of the conversation when Hart asked me to pick him up from work yesterday — which was the second day of a horrendous migraine. It was one of those weird moments where I watched myself from afar, thinking how strange those words were. “Normal” people don’t lie in empty bathtubs until they can stand up.

I did make the drive there and immediately relinquished the driver’s seat to Hart. Then came the fun part. I needed to get “feminine care products” (I HATE that phrase, but that’s another subject). I couldn’t send my sweet hubby out on his own to differentiate between an extra-super minuscule maxi pad with wings and an ultra extra-long light-day invisible maxi pad. That’s just too cruel.

In the Safeway aisle, I could barely stand up and my mind was obscured by migraine fog. I stared at the shelves, dumbfounded by the options. Each brand has it’s own name for each type, and each type has some distinguishing feature that does nothing to distinguish it from the rest. There are helpful pictures on the packages, except that every picture is identical. It would have been easier to buy a car in my impaired state than to pick out a package of pads.

Why am I regaling you with menstruation-related stories? Because we all have those can’t cope moments where headaches or migraines or the associate neurological weirdness is just too much. And because I have the sneaking suspicion that some of my migraines are linked with my cycle. My doctors and I have all concluded that the two don’t seem connected for me, and birth control pills have never reduced the frequency or intensity of my migraines, so I’m wary that this is a red herring. But my symptoms have been changing recently, and I would be overjoyed if hormonal birth control could keep some of the misery in check.

Researching this topic, I’ve learned an important distinction. A woman with menstrual migraines only has migraines during her period. If a woman has migraines during her period as well as at other times of the month, she has menstrually related migraine.

Some other important information I’ve found: Studies indicate that menstrual migraine is related to the drop in estrogen that occurs right before a woman starts her period. Diagnosis of menstrual migraine is based on a sufferer’s detailed headache diaries.

That’s all I can handle writing about right now. The fall 2005 issue of ACHE‘s newsletter is devoted to hormones and migraine, so I have a well of information to draw from. But it will have to wait until I’m up to sitting at my computer again.

For more information on menstruation, hormones and headaches, visit the National Menstrual Migraine Coalition‘s site or see the National Headache Foundation‘s hormone topic sheet. Or if you know someone who is a member of ACHE, ask to borrow the latest newsletter.