Menstrual headaches appear to occur when estrogen levels in the blood drop during the menstrual cycle. Estrogen is involved in setting the threshold for pain activity. Falling estrogen levels are associated with a greater sensitivity to pain and increased activity in body systems that cause inflammation. These changes can make women more susceptible to experiencing several different types of pain, such as headache, cramps, and muscle or joint aches, just before or during their menstrual period. Taking oral contraceptive pills (i.e., birth control pills) can exaggerate the drop in estrogen levels before the start of menstrual bleeding. Consequently, taking the pill can sometimes worsen migraine patterns. Many women will experience an improvement in their migraine after menopause.
There are a number of medicinal and non-medicinal treatments for the prevention of menstrual migraine. These treatments often work best if combined.
Non-Medicinal Treatments for Menstrual Migraine
Women with migraine are generally more susceptible to dietary, physical, environmental, and other triggers for migraine attacks during the week before and the first few days of their period. Following are some guidelines that can decrease the likelihood of having a migraine from these triggers.
Eat regularly scheduled, well-balanced meals. Avoid missing meals because low blood sugar and hunger are frequent triggers for migraine attacks. On the other hand, avoid eating sweets or meals the contain a lot of carbohydrates because doing so might lead to a rapid drop in blood sugar levels two to three hours after you have these foods (this is sometimes called a "sugar or carbohydrate crash").
Drink plenty of fluid. Avoid dehydration because this too is a frequent migraine trigger.
Get a good night's sleep. Follow a regular and consistent schedule of waking and sleeping. Avoid going to bed late, "sleeping in," becoming sleep deprived, or a haphazard sleep schedule.
Stay away from well-known migraine triggers such as wine, beer, or other alcohol containing drinks; chocolate and other sweets; aged cheeses such as cheddar or Brie; and salty foods, especially during the week before your period.
Participate in a regular aerobic exercise program. If you have not been exercising regularly, discuss exercise plans with your doctor and set up a physical conditioning plan that matches your needs. Start your exercise program slowly and gradually build up your level of activity as your physical condition improves.
Learn and regularly practice biofeedback and other relaxation techniques. These types of treatment have demonstrated excellent benefit in clinical studies; and best of all, there are no potential side effects.
Short-Term Prevention of Menstrual Migraine
Short-term migraine prevention, often called "mini-prophylaxis," can be used to preemptively manage predictable migraine attacks such as those related with menstruation or ovulation. Your physician may prescribe a medication that you begin taking a day or two before the expected onset of headache and continue taking on a regular daily schedule for five to seven days. There are several medications that have been used for mini-prophylaxis of migraine, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some triptans.
Long-Term Prevention of Menstrual Migraine
Long-term prevention, which means taking preventive medication(s) every day of the month, might be required if migraine attacks occur too frequently (i.e., averaging more than four headache days in a month), migraine attacks cause too much disability, or medications used for mini-prophylaxis are not effective, too expensive, or unsafe to use because of other medical conditions. There are many different kinds of medications prescribed for long-term migraine prevention.
The medications most often used for migraine prevention are blood pressure lowering drugs such as beta-blockers or calcium channel blockers, antidepressants and antiepileptic drugs. Each medication in these classes of medication has its own benefits and side effects. Your physician will determine which medication is best for you. Sometimes you may need more than one medication to control particularly resistant headaches. It is not unusual to try several medications or combinations of medications before the best treatment is found. It might take several weeks for a medication to demonstrate its benefit.