Saturday, October 02, 2004

Menstrual Migraines and Period Control

Not all headaches are created equal: migraine headaches affect more than twice as many women as men. Interestingly, in 60-70% of women, the headaches are related to the menstrual cycle. Period-related headaches that occur from one week to 3 days before the start of your period are called premenstrual migraines. The ones that occur from 3 days before the start of your period to 2 days afterward are called true menstrual migraines.

Menstrual headaches are a classic example of a problem thought to be caused by cyclic hormone changes. Researchers suspect falling and/or low estrogen levels trigger these types of headaches. Either the estrogen made by your body or the synthetic estrogen found in birth control can be the culprit. This means menstruating women, as well as women who use a hormonal birth control method like the Pill on the regular 3 weeks on/1 week off are prone to period-related headaches. Why?

During the menstrual cycle, your body's hormones (both the local ones like estrogen and progesterone, and the control ones like FSH and LH) go up and down. For example, at the end of your period, your estrogen levels start going up, hit a peak about midcycle, and then decline sharply right before the start of your next period. Similarly, when you're taking the Pill, your fake period is triggered by withdrawing the synthetic hormones for one week. In particular, the level of synthetic estrogen goes down suddenly (it takes the body about 24 hours to clear the Pill hormones out of the body), before your own body has a chance to rev up to produce enough estrogen to replace it.

In either case--a dip in natural or synthetic estrogen levels--the result can be a menstrual headache. Can period control help with menstrual migraines? Let's look at some studies.

1. One study measured the timing, frequency, and severity of hormone-related symptoms, including period-related headaches, in 262 Pill users. (The breakdown was 193 current users, and 69 new users). Specifically, the aim was to compare the pattern of headaches during the active-pill (the three weeks with hormone-containing pills) and the placebo pill (the one week hormone-free) interval.

Current users had more headaches during the placebo week than during the three active-pill weeks (70% vs. 53%). Similar headache patterns were seen in new users after the first cycle of use.

CONCLUSION: Headaches were significantly worse during the placebo week interval than during the three active-pill weeks. In other words, although using the Pill on the regular 3 weeks on/1 week off regimen helps with period-related headaches, women on this regimen still experience more headaches during the 1 week off.

2. Another study looked at 50 Pill users who were experiencing period-related problems, like menstrual migraines, during the placebo week. Migraine was the second most frequently occurring problem cited by the women (the most frequent was dysmenorrhea, or a painful period)--78% for dysmenorrhea and 76% for migraine. Also, migraine was most often ranked as the most severe problem (48%). To control their period-related problems, the women were given the option to use an extended, menstrual management regimen.

Women chose a 12-week (84 days on/7 days off) regimen, a 9-week (63 days on/7 days off) regimen, or a 6-week (42 days on/7 days off) regimen. All the women who used an extended regimen reported a delay in onset and a decrease in the severity of period-related problems. Interestingly, one woman reported many days of breakthrough spotting but continued to use the extended Pill regimen because of the relief she experienced from the migraines she used to have during the placebo interval.

CONCLUSION: Using an extended, menstrual management regimen (delaying the fake period by extending the number of consecutive days of active, hormone-containing pills) is well tolerated and efficacious. In other words, using an extended regimen, and shifting the frequency of the fake period from monthly to once every 12 weeks (or 9, or 6 weeks) reduces the placebo-related headaches experienced by women who use the Pill.

3. Finally, a study measured the acceptance and use of extending the number of active-pill days beyond three weeks and/or shortening the placebo interval. All 292 Pill users reported experiencing problems, like headaches, pelvic pain, etc., during the placebo week. The women who chose to use the extended regimen typically used a regimen of 12 weeks on/6 days off. The most common reason given for choosing the extended regimen was headache (35%), followed by dysmenorrhea (21%), heavy periods, or hypermenorrhea (19%), and premenstrual symptoms (13%). Other reasons were: convenience and endometriosis.

In terms of symptom improvement, 86% of the women on the extended regimen reported that their symptoms improved (compared to 41% of women on the regular 21/7 regimen). In terms of quality of life improvement, 94% of the women on the extended regimen reported quality of life improvements (compared to 43% of women on the regular 21/7 regimen).

CONCLUSION: The majority of patients with hormone withdrawal symptoms on OCs [Oral Contraceptives] will initiate a regimen of extending active pills, often with a shortened hormone-free interval to reduce frequency and severity of associated symptoms. In other words, the majority of Pill users who experience symptoms during the placebo week prefer to use an extended, menstrual management regimen to reduce the frequency of the fake period (from monthly to once every 12 weeks), and to lessen the severity of the placebo week symptoms.

Bottom line: For women who experience menstrual migraines and are considering period control, a good first step is using the Pill on the regular 3 weeks on/1 week off regimen. This accomplishes the following:

  • the period is suppressed for the entire month (actually, it's suppressed for the entire time you use the Pill--months, years)

  • the body hormones no longer fluctuate

  • the Pill hormones only fluctuate one week per month

  • a monthly fake period pattern is established

  • If the regular 3 weeks on/1 week off regimen doesn't help, the next step is using an extended Pill regimen. This can be a 6-week (42 days on/7 days off), a 9-week (63 days on/7 days off), a 12-week (84 days on/7 days off) regimen, or any other regimen that fits your unique needs. This accomplishes the following:

  • the period is suppressed for the entire month (again, it's suppressed for the entire time you use the Pill)

  • the body hormones no longer fluctuate

  • the Pill* hormones only fluctuate once every 6, 9, 12, etc. weeks

  • a shift in the fake period pattern, from monthly to once every 6, 9, 12, etc. weeks

  • Other menstrual migraine treatments include: non-steroidal anti-inflammatory agents (NSAIDs like ibuprofen), 5-HT-1 agonists (sumatriptan), daily prophylactics (beta blockers, calcium channel antagonists, tricyclics), and other hormonal regimens (danazol).

    Menstrual migraines are common and they can be very disruptive. Although we don't yet fully understand what causes these headaches, treatments are available. So, if you experience period-related headaches, there's no need to suffer in silence. Ask for treatment, and expect relief.

    *monophasic Pill brands


    At 10:15 PM, Anonymous Anonymous said...

    Yeah, I had to get off the pill because of the migraines. They switched me to one with lower estrogen, which helped some, but not enough. That's why I switched to Depo (no estrogen and no break in coverage). I haven't had a real migraine since then.

    My doctor thinks it may have helped with IBS problems, too, which could have been triggered by the same estrogen receptors.


    At 10:06 PM, Anonymous Anonymous said...

    Thank you for this information. I take birth control pills and have been suffering from debilitating headaches starting on the first or second day of my period for months now. I had been mulling over period control as a possible solution and I am glad to have found some information.


    At 2:53 PM, Anonymous Anonymous said...

    I found your information so helpful. I have been getting HORRIBLE headaches on the second day of my period for the past 3 months - so bad I cannot care for my 2 small children. I am going to talk this option over with my doctor.

    At 9:18 PM, Anonymous Anonymous said...

    Good helpful information! I am 45yrs and not on any birth control pills. I have been suffering period migraines for past 3 months. They are so severe lasting up to 5 days with no relief. I visited GP who did not really give much help but after reading your information i will be going back and feel more equiped to discuss treatment.

    At 11:36 PM, Anonymous Anonymous said...

    I've been on birth control pills for years, I take them continuously for 3 months before taking a one week break for my period. Yet, even supressing my period I'm having terrible migraines every 4 weeks anyway. Maybe the pills are my actual problem, I may try taking a break from the pills to see if I have any improvement. I have FMLA and I hate missing work and missing out on life! So unfair!

    At 6:05 AM, Anonymous Tamara said...

    Hi i have been getting menstral migraines for the last 15yrs every month with out a doubt , they will last the whole time i have my cycle which is about 7days , it causes me so much pain 24hrs around the clock without a break until i have finished them , put it this way if i did'nt have my two children i would of done myself in a very long time ago .
    It has such a massive impact on my life , it is so hard to care for my children go to work , and have any knid of life , e.g someone will invite me to something and if it is at that time of the month i have to decline as i know where i will be in bed throwing up and suffering from the pain , so as it approaches this time of the month i start to shit myself and become so heart broken and frustrated as i know what is coming .
    i have had an abblation done on my uterus i was hoping that it would be successful and i would never get my periods again as it has for many women but not me NO !! ,it has lessoned my cycle flow and the period pain i used to get but not the migraines as i still get my period lightly , i am so sick of taking pain medication , i dont want to treat the pain i want to treat the PROBLEM!!! which is clearly the hormones : ( you know what it really sux being a women and next life i am coming back as a man .
    I did have a gyno , but he was just a money hungry moron that really at the end of the day didnt give a shit the dr that i see just sits there like a stunned mullet and shruggs her shoulders and says there is not alot we can do i mean come on we are living in the 21st century now you would think that with the technology today they would be able to cure the god dam common headache and the migraines , and i do believe they can its just the drug companies that dont want to loose there money so us poor people have to suffer have to go through hell just because they want to make a dolloar out of us : ( , i cant have a hysterorectomy because of my two ceaser's i have had with my kids and the abblation i am considered a high risk , so they all say dont suffer in silence we can help you , well im not being help and i have been to hell and back that many times i cant remember and i will be going there again in about two weeks and i will be suffering in my room i silence , i am crying now because i can not live my life like this anymore and i do not want to either but what choice do i have , i am going to my doctors again on monday to see if she can do a blood test to see what hormone i am lacking in and if she says no to it and that they can not do it i will scream , i have been told before but i dont understand if they can do it for menopuse why cant they for me i am 37yrs old and have this disease called menstral migraines it has broken my soul and that is what i considerate it to be a crippling disease that gets hold of me once a month : ( i have tried everything from modern medicane to herbal gurus and still i am suffering ,i just dont know what to do anymore : ( thanx for listening .

    At 3:50 AM, Blogger ema said...


    I am terribly sorry to hear of your serious problem with menstrual migraines. Now, keeping in mind that only your doctor can give you medical advice, a couple of things:

    Why are you still having periods? The first line of treatment in situations like yours (assuming no contraindications, of course) is to suppress the period indefinitely.

    I'm a little puzzled about the endometrial ablation as that doesn't solve anything.

    Anyway, the first thing to do is to start a continuous regimen of combination birth control pills--no placebo pills, just active pills. This will eliminate the period (the monthly hormone fluctuations) and, hopefully the monthly trigger for the migraines.

    Since I take it you are done with childbearing, there's no need for you to have monthly periods.

    If the continuous regimen works, great. If not, a trial period of something more powerful like Lupron for 3-6 months should do the trick. (This is not something you can use alone for long term because it's like an artificial menopause, and you still need an estrogen add-back. Given the debilitating effect of the migraines this is something you might want to discuss with your doctor.)

    Bottom line: Suppress your periods immediately and see what happens.

    Hope this helps.

    At 12:04 PM, Anonymous Tamara said...

    Thankyou so much ema , i will talk to the doctor about the information you have given to me , i see the light at the end of the tunnel , i had the abblation done thinking that it would do the job and stop my cycle but because i have a back to front uterus it wasnt so succesfull , so i still get them not heavy like i used to which was really heavy and i used to bleed for up to 15 days at a time it was horrible , so the abblation has given me relief from that side but still getting the migraines every month , so i can go in there monday with a bit more of an idea thanks to you ema i had know idea you could take something to go through an early menopause , why dont they tell you things like this ? she should of dicussed everything with me all of my option's not try and give me pain medication, it is so frustrating and she cant just sit there now and shrug her shoulders i will not be leaving until she can help me after all that is her job ,i dont know but i have been reseaching on the net about the minni pill with only progesterone in it nothing else because when i went to the health guru they did prescribe the cream to apply 212 to 14 days into my cycle , it did reive me somewhat from memory , but i will discuss it with her on monday , i appreciate the time you have taken to read and listen and advise me thanks again and take care ema ; ) xx

    At 4:07 PM, Anonymous Anonymous said...

    Tamara- Did you have success getting rid of your migraines?


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