The Headache Network » Hormones and migraine

Menopause and migraine

admin — Tue, 08 Nov 2011 02:14:44 +0000

The good news is that for many women migraine improves, often dramatically, once menopause is reached. This may be especially true for women who previously had many menstrually related migraine attacks. In menopause, the monthly hormonal fluctuations stop, and therefore they can no longer trigger migraine headaches.

The bad news is that women who have hormonally sensitive migraine attacks may go through a difficult several years during the perimenopausal period just prior to reaching full menopause. This is though to occur because during the perimenopausal time period, large fluctuations in blood estrogen levels can occur, often in an irregular pattern.

Once again, special treatment strategies, some of which may involve different types of hormonal replacement treatments for a time, can be tried. If perimenopausal worsening of migraine becomes a major problem and can not be controlled with the usual migraine treatments, it is worth discussing this with your doctor.

Also, a minority of women with migraine do not have improvement with menopause. Careful attention to migraine treatment can however usually lead to satisfactory management of the migraine attacks.

What about pregnancy?

admin — Tue, 08 Nov 2011 02:14:29 +0000

During pregnancy, estrogen levels in the blood rise steadily and become very high. Fortunately, they do not have the fluctuations with sudden drops in blood levels that are seen during the normal menstrual cycle. As a result, migraine tends to improve in most women during pregnancy. A minority, perhaps 10%, will have a worsening of their migraines, particularly during the first trimester (the first 3 months) of pregnancy. This is often then followed by improvement. A severe migraine attack may happen shortly after the birth of the baby, however, as the mother’s high estrogen blood levels fall rapidly after she gives birth. Migraines are especially likely to happen in the mother at this time if the mother has a history of migraine attacks which tend to come on with menstruation.

If migraine attacks become a problem during pregnancy, there are a number of special considerations when it comes to treatment. An important one is that many commonly used migraine medications cannot be taken during pregnancy as they have not been proven safe for the unborn baby. This is an important thing to discuss with your doctor.

Migraine and oral contraceptives

admin — Tue, 08 Nov 2011 02:14:16 +0000

Most women with migraine can take oral contraceptives relatively safely. This is an issue which it is worth discussing with your doctor, however, as both migraine and oral contraceptives do increase the risk of stroke very slightly.

In otherwise healthy women, this risk is so slight that the benefits of the oral contraceptives usually outweigh the risks. However, in women with migraine who also have other factors that could increase their stroke risk, such as smoking, obesity, or high blood pressure, caution and careful discussion with your doctor is advisable. Also, when it comes to migraine and oral contraceptives, migraine with aura is more of a concern than migraine without aura. Otherwise healthy young women with migraine with aura may still find that the benefits of the pill outweigh the small risks, but if the migraine auras are prolonged or unusual in some way, then it may be best to avoid the pill. The same may be true for women with migraine who are older (over age 35). Other methods of birth control may be a better bet for you. The best advice is that if you are going to ask your doctor for oral contraceptives, make sure your doctor knows you have migraine; and if you have auras with your migraine describe these to your doctor. Then make a decision together as to which method of contraception is best for you.

In any case, if a woman with migraine does start the pill, it is advisable to watch for any change in the migraine. If for example, a woman develops migraine auras for the first time after starting the birth control pill, it may be best to stop the pill.

Migraine and oral contraceptives

admin — Tue, 08 Nov 2011 02:13:56 +0000

Migraine and the menstrual cycle

admin — Tue, 08 Nov 2011 02:13:37 +0000

A woman’s estrogen levels rise and fall during the monthly menstrual cycle, with a peak in blood estrogen levels at mid cycle just before ovulation. This is followed by a small drop in estrogen levels, and then a much larger fall in estrogen levels occurs just before menstruation. After a few days, estrogen levels slowly start to rise again.

In many women, the falling estrogen levels tend to trigger migraine headaches. This may happen at mid cycle, but much more commonly occurs with the larger drop in estrogen levels just before menstruation. The majority of women will notice some influence of their menstrual cycle on the timing of their headache. For a few women, virtually all their headache attacks are menstrual migraine attacks, and occur in the few days before or after the onset of menstruation.

In some women, menstrual migraine attacks can be longer and more severe that their other migraine attacks, and can be particularly difficult to treat. Fortunately, specific treatment strategies exist for attacks of this nature, which will be discussed in the treatment modules of this website.