Menstrual Headaches are Driving me Crazy!!


There are many different triggers for headache but did you know that the changes in your hormone levels around your period can be a significant one?


If you get significant headaches, it might be worthwhile keeping a very simple diary and tracking your headaches to see if they are cyclical and occurring the week before or the week of your period. If this is the case it is quite likely that you have “menstrual migraines”. That means that it is the drop in estrogen levels which triggers your headaches.


The great news about this is that there are a variety of different ways we can successfully treat this.


1. Treatment of the headache once it is here.


Non-medication strategies to reduce headache include ice packs, rest, acupuncture and TENS machines. A TENS machine for headache involves placement of a small electrode on the forehead which stimulates one of the main nerves involved in headache (the trigeminal). This reduces the headache intensity.


Medications for headache include taking two paracetamols with two ibuprofen. Alternatively, you could take 3 x 300mg dissolvable aspirin instead of ibuprofen for a faster effect. Always take anti-inflammatory medications with some food and check with your GP or pharmacist that you don’t have any health conditions which would make it unsafe to take these types of tablets.


If your headaches are more classic migraine-type, you might get more effective relief by taking a class of medications specific to migraine called triptans and ergotamines. Their mechanism of action is completely different to paracetamol and anti-inflammatories. Triptans work by dampening down pain nerves in the brain.


Ergotamines work by altering blood flow patterns in the brain which might be associated with migraine. It is very important to take migraine-specific medications at the earliest sign of onset of your migraine.


If you aren’t sure if you are getting headaches or migraines, have a chat to your GP to help you differentiate. In general, migraines tend to occur on one side of the head, be more throbbing in nature and are associated with nausea and intolerance to light and sound.


2. Prevention of headaches.

If your period is regular, you can start taking an over-the-counter anti-inflammatory, like ibuprofen, a few days before you expect your period to begin and continue until your period has finished. If this is successful, you might want to see your GP for a prescription for a longer acting anti-inflammatory so that you only have to take one tablet per day throughout this time.


If this is not successful, sometimes preventing your period with the use of contraceptive medications can be very helpful. This is because your body is not experiencing the sudden estrogen drop. Some examples of this are taking the combined oral contraceptive pill (COCP) and running the cycles together so you do not get a period, or having a long-acting contraceptive implant inserted which stops ovulation and the cyclical hormone changes.


If you get migraine headaches and experience an aura or warning such as visual changes like flashes or floating images in your vision or unusual smells which tell you that a migraine is coming the COCP unfortunately is contraindicated for you. This is because there is a slightly increased risk of stroke with this type of migraine. It is thought that these warning signs or auras preceding the headache might be caused by constriction of blood vessels in the brain. If you get migraines without aura, you can safely use the COCP to prevent your period and menstrual migraines.


Other ways to prevent migraines in general and menstrual migraines include beta blockers which lower blood pressure, anti-convulsant medications, antidepressants; which address nerve pain, Botox injections and more recently released monoclonal antibody injections. Most of these need to be taken every day to be effective, not just when you have headache.


In summary, don’t suffer with menstrual headaches!


If you are getting headaches regularly, please come and see your GP to work out a treatment plan.


References

1. Mayo Clinic: Headaches and hormones: what’s the connection? https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/in-depth/headaches/art-20046729 <15/06/21>