Living with Migraine : Women’s Health

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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.
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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