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Menstrual Migraine

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

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.

For helpful strategies to manage Menstrual Migraine, read our blogs on Diet,  Sleep Hygiene and Understanding Triggers.

Reference:

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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Menstrual Migraine – Frequently Asked Questions

What is a menstrual migraine?

A menstrual migraine is a type of migraine that occurs in connection with a woman’s menstrual cycle, typically due to hormonal changes, particularly the drop in oestrogen levels. These migraines can occur with or without aura and are classified based on their timing and the presence of aura.

What causes menstrual migraines?

Menstrual migraines are primarily triggered by the natural drop in oestrogen levels that occurs just before menstruation. This hormonal fluctuation can lead to migraines. Other factors, such as stress, changes in sleep patterns, or dietary habits, can also play a role.

Can menstrual migraine be treated?

Treatment for menstrual migraines often includes medications that target nerve sensitivity in the brainstem, such as triptans, CGRP injections, or Botox. Since hormonal changes are hard to control, another effective approach is to desensitize the brainstem, making it less reactive to these hormonal triggers.

The Watson Headache® Approach, offers a unique hands-on technique that addresses overstimulation of the brainstem caused by issues in the upper neck.

What can I do to relieve menstrual migraines?

To relieve menstrual migraines, you can take pain-relief medications at the onset of symptoms, The Watson Headache® Approach which is a specific manual technique to treat cervical spine dysfunctions, which helps reduce nervous system sensitisation and alleviate migraine symptoms. Additionally, potentially reducing the need for medications over time and allowing for better self-management of the condition.

What do menstrual migraines affect?

Menstrual migraines can affect daily activities, work, and social interactions due to the pain and associated symptoms like nausea, vomiting, and sensitivity to light and sound. These migraines can be debilitating, requiring rest and possibly time off from regular activities.

Can menstrual migraine be serious?

While typically not life-threatening, menstrual migraines can be very painful and disruptive. If having migraine around your cycle is unusual and you are concerned then it’s important to seek medical evaluation to rule out other possibilities.

How often do menstrual migraines occur?

Yes, menstrual migraines are common among women who experience migraines. Approximately 50% of female report menstrual-related migraines, and around 10-20% experience migraines exclusively related to their menstrual cycle.

Can menstrual migraine become a more serious problem?

Menstrual migraines can lead to chronic migraines if they become frequent and poorly managed. This is a condition where migraines occur on 15 or more days per month.

Are menstrual migraines common?

Yes, menstrual migraines are common among women who experience migraines. Approximately 50% of female report menstrual-related migraines, and around 10-20% experience migraines exclusively related to their menstrual cycle.

How long can menstrual migraine last?

A menstrual migraine can last from several hours to up to three days. The duration varies depending on the individual and the treatment. In some cases, symptoms may linger longer if not managed effectively.

What causes migraine?

What causes migraine?

Migraines can be debilitating due to their moderate to severe intensity. If you experience a migraine, you may be out of action for at least a couple of hours or even up to three days! More than...

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