| Q: |
I have severe menstrual migraine. What I can do to reduce the likelihood of having attacks?
| | A: |
It may be helpful to track menstrual cycles on your migraine
diary. The falling estrogen levels, which occur 2–3 days before the
first day of menstruation, trigger the menstrual migraine. You need to
start your menstrual migraine treatment before the onset of the attack.
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| Q: |
Even if I am unable to avoid a menstrual migraine, is there anything I can do to decrease the severity?
| | A: |
By avoiding migraine triggers, maintaining your exercise and
relaxation routine, and reducing some of your activities, you can reduce
the severity of your menstrual migraine and make it easier to abort. If
you know that you are premenstrual by tracking your cycles, then you
will be better able to make the changes.
|
| Q: |
Can I take my abortive therapy before the attack?
| | A: |
Using abortive therapy, specifically NSAIDs and triptans, daily
for 3–4 days before the menstrual attack can be very helpful. You need
to discuss this approach with the doctor who is treating you. The
avoidance of migraine triggers during the week before menstruation is
very important. By avoiding triggers and using the abortive medications
you may be able to avoid the attack.
|
| Q: |
I have friends who take continuous oral contraceptives to prevent
a menstrual migraine. Is that something I could do as well?
| | A: |
The use of oral contraceptives to treat menstrual migraine can be
very helpful. Taking these contraceptives without a break means that
estrogen levels in the blood do not fall or that the drop is less rapid.
Since menstrual migraine is caused by the falling estrogen level,
continuous use of contraceptives prevents the attack. You will need to
discuss the use of continuous oral contraceptives with your gynecologist
to know if it is a treatment option for you.
|
| Q: |
Sometimes I don’t have menstrual migraine, but I do feel anxious
and depressed during menstruation. Is this migraine or PMS?
| | A: |
That is a very good question, one I am not sure your gynecologist
or a neurologist could answer. There is significant overlap between
premenstrual migraine and premenstrual syndrome. They may be separate
serotonin conditions or symptoms of the same serotonin—estrogen related
condition. Many women experience both, and the treatment options are
nearly identical.
|
| Q: |
How can I help my friends and family to better understand my menstrual migraine?
| | A: |
You can provide them with information regarding menstrual
migraine and how changes in estrogen levels trigger a migraine attack.
Family and friends, especially women, may be very interested in learning
about estrogen and how it affects brain function. Some of your friends
may simply need the reassurance that you are doing everything you can to
feel well.
|
| Q: |
“Not tonight honey, I have a headache.” Is having a headache a legitimate reason for not having sex?
| | A: |
It depends upon the severity of the migraine attack. A mild
migraine attack could be aborted by the endorphins that are released
during intercourse. A more severe attack with nausea and vomiting would
make it difficult to do anything, let alone have sex. Coital headache is
a type of headache that can occur during sexual climax. It can be
easily treated by taking indometacin an hour before sexual intercourse.
|
| Q: |
If I have migraine can I use oral contraceptives?
| | A: |
Oral contraceptives containing estrogen can make women who have
migraine with aura more vulnerable to stroke, so it depends on the
number of other risk factors you have. Risk factors include: age over 45
years, smoking, hypertension, heart disease, and diabetes. If you have
migraine without aura and no other risk factors, then a low-dose
estrogen oral contraceptive can be taken.
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