Menstrual Migraine Headaches
Frederick R. Jelovsek MD
Migraine headaches are more common in women and 60-70% of women
with migraines report some relationship with their menstrual
period. Usually there is an increased frequency before, during
and after menses. There is a category of migraine that is called
a true menstrual migraine. This is a migraine headache
that occurs regularly, each month but only between the 2nd day
before the menses and the end of menstruation. Menstrual migraine
is thought to occur in about 14% of women.
The reason it is important to diagnose this subcategory of
migraine is because it seems to be triggered by falling estrogen
(estradiol) levels at the end of the menstrual cycle. Therefore
it is quite treatable with low doses of estrogen starting one to
two days before menses and continuing throughout the menstrual
flow. Menstrual migraine can also be a problem on birth control
pills. In this case, the migraine occurs in the seven days off of
the active pills (during the seven different colored inactive
sugar or iron pills). This can also be treated with low dose
estrogen during that seven days.
Sometimes, what is a migraine headache versus what is just a
chronic tension-type headache gets confused. A recent
publication, Ling FW et al (eds.): Strategies for the
management of headache. Association of Professors of Gynecology
and Obstetrics Educational Series on Women's Health Issues.
1998, had a good discussion of the different types of
headaches in women. They organized the International Headache
Society classification of headaches:
Headache Diagnostic Criteria
| Migraine without aura |
Migraine with
aura |
Chronic tension-type |
| At least 5 attacks fulfilling the following criteria: |
At least 2 attacks having at least 3 of the following
characteristics:
|
-- |
| headache lasts 4-72 hours if untreated |
one or more aura symptoms occur and are fully reversible
|
average frequency of 15 days per month for 6 months |
| headache includes at least two of the following
characterisitcs -- unilateral location, pulsating quality,
moderate to severe intensity which inhibits or prohibits daily
activity, aggravation by routine physical activity
|
at least one aura symptom develops gradually over more
than 4 minutes or 2 or more symptoms occur in succession.
|
at least 2 of the following pain characteristics:
pressing or tightening, mild or moderate severity, bilateral
location, not aggravated by physicial activity
|
| headache is accompanied by at least one of the following
-- nausea and/or vomitting, light or sound sensitivity
|
no single aura symptom lasts more than 60 minutes
|
no vomiting |
| -- |
headache begins just before or within 60
minutes of an aura |
nausea, light or sound sensitivity |
| Plus |
| other disease/disorder process is ruled out or if present,
migraine attacks do not occur for the first time in close
temporal relation to the disease/disorder
|
secondary cause excluded by a medical evaluation
|
-- |
Almost one in six women are thought to suffer from migraine
headaches with a peak incidence between ages 25 and 55. Of those
women only about 40% have been diagnosed by a physician.
|
