Many women dread approaching periods for the cramps and the wet ickiness that become the order of the day. But not me! All the hassles of menses are nothing in comparison to the skull-crushing migraine I get somewhere around the time of menstruation. At first, I thought it was just a mere coincidence that I was getting migraine every month around the same time. But it turns out, it wasn’t all in my head (pun intended) because menstrual migraine is really a thing! And like me, many women experience debilitating headache around the time of their periods…!
They say that four out of every ten women and two of every ten men contract migraine in the course of their lives. This means, when it comes to migraine, women outnumber men at least by a 2:1 ratio! In fact, after menarche (the first occurrence of periods), women have an increased prevalence of migraines as compared to men, and it keeps increasing till the time the woman reaches her mid 40s. Also, the pain and frequency of migraines in women is more than those in men…
This obviously points to a link between migraine and female hormones. Migraine is also called a “predominantly female disorder”; no surprises there! The incidences of menstrual migraine occur on days directly before and after the first day of menses.
And for most of who suffer from the condition, migraines are quite common on the other days too. A drop in the oestrogen levels is said to be the culprit triggering episodes of migraine in women. Apart from this, the release of prostaglandin also has a role to play.
What are the acute treatment options for menstrual migraine?
Like nonmenstrual migraine, acute treatment of menstrual migraine should include a variety of methods. Some of the best acute treatment options are:
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs work by blocking the ezyemes and protiens made by the body. By doing so, the reduce swelling and pain. They are the first-line agents for migraine associated with painful cramps and heavy bleeding in women during menses. For treating menstrual migraine, the drug naproxen has been proven to be effective. Apart from reducing the pain, it also takes care of migraine symptoms like light sensitivity,nausea and light headedness seen in migraineurs.
Estradiol: Supplementing your body with oestrogen artificially when the level dips is a good way to keep menstrual migraine at bay. Estradiol is a female hormone produced by the ovaries. Stage 1 of your menstrual cycle is known as the luteal phase where the oestrogen levels are sufficient.  So by introducing estradiol into the body artificially, can mimic the luteal phase of menses, reducing attacks of menstrual migraine. A dose of 1.5mg estradiol gel is enough to do the trick.
Triptans: Triptans are a class of drugs used for treating migraine since it works by narrowing the blood vessels and relieving the swelling. Since migraine is basically a vascular disorder, this mechanism of the drugs can help in reducing the pain. Common triptans like frovatriptan, naratriptan, sumatriptan and zolmitriptan taken around the time of menses have been shown to be effective.
Magnesium: A 360mg dose of oral magnesium can be taken on the 15th day of the menstrual cycle and continued till the next periods for two months as a continuous treatment option for migraine. It is a safe and a trusted way to prevent migraine attack during menses.
Combined hormonal contraceptives: These oral contraceptive pills are a combination of ethinyloestradiol and progestogen, types of oestrogen and progesterone respectively. By taking the pill, migraineurs can maintain a good level of oestrogen in the body, thereby preventing instances of menstrual migraine attacks. It is recommended that women take these pills for three weeks followed by one week of inactive pills or no therapy to prevent oestrogen-withdrawal-related migraines in women.
Progestogen-only contraceptive: Although combined hormonal contraceptive therapy is effective for menstrual migraine, there is a tiny but significant vascular risk or risk to the blood vessels. This is seen especially in cases of migraine with aura. Even those who have migraine without aura, there is an underlying risk of stroke in women over age 35, especially if they smoke, have hypertension, diabetes or thrombophilia. So in such cases, it is better to use progestogen -only contraception as an alternative to prevent menstrual migraine.