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Effect of reproductive hormones causing headaches

Research has shown that changes in reproductive hormone levels before, during and after menstruation may be the reason behind the patient suffering from severe headaches.

This condition may be referred to as menstrual migraines. The following criteria have to be met to diagnose a patient with this condition. They are as follows:

  • The migraine doesn't include experiencing an aura (sense of a headache about to come on).
  • The headaches occur 2 days prior to and up to 3 days following the onset of menstruation.
  • These headaches have to occur in 65% of menstrual cycles.

The main reason behind these headaches is most probably due to a sudden drop of oestrogen levels that occurs just before the time of menstruation. Other physiological changes that occur during this time also seem to play a role, but the main issue is the drop in oestrogen levels.  

Managing menstrual migraines

Conservative measures that can be applied to help alleviate the symptoms of menstrual migraines include the following:

  • Applying an ice pack or cold cloth to the painful area of the head or neck. Make sure to wrap the ice in a towel or cloth material to protect the skin.
  • Relaxation exercises help to reduce stress and tension.
  • Acupuncture may also help to reduce tension.
  • Over-the-counter medications such as paracetamol can help offer some relief.

Acute, short-term treatments which can be used to help alleviate the symptoms caused by this condition may include the following:

  • Triptan medications which are specifically used for migraines.
  • Non-steroidal anti-inflammatory medication which help to bring relief to both migraine and tension-type headaches.
  • Magnesium supplementation can help due to the sudden drop of magnesium levels in the body during this time.

Long-term hormonal management of menstrual migraines is indicated for patients who are struggling to be treated with short-term methods and includes the use of combination oral contraception (OC). This would include both oestrogen and progesterone containing medication. The way this OC is to be used is by using 3 months of the medication and omitting the placebo week every month for this time period. The placebo week's tablets can then be used at the 4th month's use of the medication. By doing so, one is preventing oestrogen levels from dropping during the premenstrual time period and therefore preventing the occurrence of the headaches. The only issue to look out for would be that this method will prevent menstruation. It would then be advisable to perform pregnancy tests at the end of each month's medication pack to exclude a pregnancy.

If hormonal treatment is contraindicated, then long-term non-hormonal management of menstrual migraines would include the use of medications such as calcium-channel blockers, beta-blockers, anticonvulsant medication and tricyclic antidepressants. These medications are also better suited for patients who have irregular menses.

If the conservative methods have not helped then it's better to consult with your primary care physician to assess you further. They will then prescribe the necessary medication to help you deal with this issue.

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