Ask the Expert: Migraine and Menopause
During menopause, there are changes called perimenopause. There are ups and downs with the way the ovaries work. Migraine attacks can come on or get worse when the changes in the ovaries, estrogen and progesterone are present.
Estrogen causes hot flashes, migraines, and changes in brain chemicals. According to my experience, women who have headaches related to hormones such as menstruation, pregnancy, and birth control are more likely to have headaches during the perimenopausal period.
The type of menopause that you go through also has an impact on whether migraine may worsen or improve. There is about a 50% to 60% chance that migraine will improve if you have gone through natural or spontaneous menopause. Women who have surgical menopause with the removal of the ovaries may have worsening migraine.
It is difficult to predict how long the period will last. The average is around 4 to 8 years, but it can be shorter or longer depending on genetics and hormones.
There are many reasons why a sudden shift in hormones can cause a worsening of migraines.
Many people ask me if hormones are the problem, and if we should start hormone replacement therapy. I can say that it is not easy. Genetics, stress, sleep, weather, foods, and hormones are some of the factors that can cause a migraine.
There are many factors to consider. Science shows that there are a few different factors that contribute to the worsening of migraines.
“There is a side effect profile that can be unpredictable, and it hasn’t been shown to be helpful in treating migraines in studies.”
The standard way to treat migraines related to menopause is by considering preventive treatments such as blood pressure medications, seizure medications, antidepressants, or onabotulinum toxin A and acute.
Treatments such as triptans, gepants, and shiramine derivatives should be considered.
Migraine attacks can be more severe around menstruation and menopause. The prodrome phase, the aura phase, the headaches phase, and the postdrome phase are the different phases of a migraine attack.
The headaches phase consists of pain on one or both sides of the head that is associated with sensitivity to light and loud noise, nausea and vomiting, and the need to rest. It is the most disabling part. A person with migraines can be impacted in different ways by each phase.
The prodrome phase can cause a lot of symptoms. Neurological symptoms can be caused by the aura phase. The postdrome phase can cause problems.
“The average lifespan of perimenopause is 4 to 8 years, but can vary based on a person’s own genetics. Migraine attacks continue even though hormone fluctuations continue.”
Migraine can be divided into two categories based on how many days a month you have attacks.
“Experiencing less than 15 headaches a month is a symptom of chronic migraines. If you don’t have an optimal treatment plan, individual migraines can be shorter or longer.”
A study shows that a daily dose of 600 magnesium can help reduce the number of days with migraines. The body has magnesium. It is responsible for making a number of things.
It also helps the brain function. People with menstrual and classic migraines have lower levels of magnesium. I see magnesium causing an upset stomach and diarrhea.
To avoid this, I often recommend starting at low doses such as 100 or 200 and increasing it over several weeks to allow the body time to adjust.
Even supplements can interact with your existing medications and your own body chemistry, so it is important to have your doctor help you with the initiation of supplements.
It is advisable to see a doctor as early as possible. By starting prevention for migraines early, you can cut down on your monthly attacks, reduce your disability, and prevent them from becoming chronic.
If you have a change in your vision, weakness in your face, arms or legs, or a sudden onset headaches, it is important to see a doctor in the emergency department.
Your doctor may need to perform a neurological exam, order blood work, and take pictures of your brain with a computed tomography (CT) Scan or magnetic resonance imagery.
It is always helpful to start with your primary care professional. If you need to be referred to another healthcare professional, your primary care professional can do an initial evaluation.
Doctors who have completed medical school and a residency in medicine are called headaches specialists. They will have to take an exam to become certified in this field after completing additional training in headaches and facial pain.
Migraine specialists often prescribe and perform procedures on patients.
If you can get an appointment, hold on and never let go.
Dr. Deena Kuruvilla is an ABMS board certified neurologist and a United Council for Neurologic Subspecialties (UCNS) certified headache and facial pain specialist. Dr. Kuruvilla has special interests in procedural and complementary and integrative medicine.