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Menstrual Migraine

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About Menstrual Migraines

What Is A Menstrual Migraine?

Predominantly a condition affecting women. These migraines usually come on, just before or during a menstrual cycle and/or during ovulation. These can present as a typical tension-type headache but can also present as traditional migraine with one-sided severe pulsating head pain.

During a women’s cycle at day 1, there is a large drop in oestrogen levels which in turn leads to a drop in serotonin levels in the brain. This drop in serotonin levels is said to be the trigger for menstrual migraine. 

Menstrual Migraine Diagnosis

How Do We Diagnose A Menstrual Migraine?

There is a debate whether menstrual migraine is a separate migraine-type or whether hormonal change is just a trigger. Nevertheless, menstrual migraines arise at -2 to +3 days of menstruation and occur at least 2 out of every 3 cycles. Pure menstrual migraines only occur during a cycle while menstrual related-migraine happen during menstruation and additionally at other times of the cycle. Clinical experience has shown that ovulation will quite often trigger an episode which is milder and shorter in duration. 

Menstrual Migraine Symptoms

Head pain

Moderate to severe throbbing or pulsating-like pain

Usually lasting 3 days

Nausea and vomiting

Increased Sensitivity

Increased sensitivity to light, sound and smell

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Treating Menstrual Migraines With The Watson Headache® Approach

Menstrual Migraine Treatment

Treatment is often focused on the use of medications which target the nerve sensitivity in the brainstem. These can include triptans, CGRP (Calcitonin Gene Related Peptide) injections or Botox.

As hormonal changes are difficult to stop or change, treatment to desensitise (or settle) the brainstem has proved an effective way to manage Menstrual Migraine. With a more settled nervous system, the body will be less reactive to triggers such as hormonal changes.
The underlying driver of migraine (brainstem sensitivity) is the same for all migraine presentations, such as dietary changes, sleep improvements, exercise, and upper neck treatment. This is why treatment of the upper neck can be effective in changing migraine symptoms.

Sydney Headache and Migraine Centre uses the The Watson Headache® Approach which focuses on addressing the underlying mechanical dysfunctions in the upper neck that can be dialling up sensitivity in the brainstem, causing migraine. Skilled physiotherapists trained in the Watson Headache® Approach utilise specific manual techniques to assess and treat dysfunctions in the cervical spine and related structures. These techniques have been proven to reduce the sensitisation of the nervous system, providing relief from migraine symptoms.

Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex Dean H. Watson, MAppSc; Peter D. Drummond, PhD, Headache 2014;54:1035-1045

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