Menstrual Migraine
Menstrual migraine is typically more severe, lasts longer and is more resistant to medication than other migraine types.
There are two types of menstrual migraine, pure menstrual migraine or menstrually related migraine
Pure menstrual migraine has been defined by the International Classification of Headache Disorders as attacks occurring either 2 days prior or up to 3 days after menstruation in at least 2 out of 3 consecutive menstrual cycles, with no other migraines at any other time of the cycle.
Menstrually related migraine with or without aura is defined by perimenstrual attacks similar to pure menstrual migraine but with additional attacks at other times in the cycle.
Menstrual migraine affects somewhere between 20-60% of all female migraineurs.
Menstrual migraine accounts for between 20-70% of all patients presenting to headache clinics.
What causes menstrual migraine
A drop in the level of the hormone oestrogen just before the start of a period has been linked to menstrual migraine. While a drop in oestrogen levels is linked to menstrual migraine, migraines can also occur around the time of ovulation when oestrogen levels are rising. Interestingly, no difference has been found between oestrogen levels in women with menstrual migraine and those with non menstrual migraine. Research demonstrates that the underlying factor in menstrual migraine like in other migraine types is the presence of a ‘sentisied’ brainstem and normal fluctuations in oestrogen may influence this sensitisation. Information from the trigeminal nerve converges with information from the upper cervical spine in the trigeminocervical nucleus within the brainstem. This normal information becomes exaggerated by a ‘sensitised’ brainstem, which alerts higher brain centres. Higher centres in the brain perceive this information as a threat and generate pain as a warning sign that something is wrong in the neck or face or both.
The team at Auckland's new Headache & Migraine Clinic have specific training in menstrual migraine, and are here to help you.
Diagnosing menstrual migraine
There are no specific tests for menstrual migraine, blood hormone levels are not useful as fluctuations in oestrogen occur all the time and research has shown no difference between levels of oestrogen in women with menstrual migraine compared with other migraine.
Keeping a diary of previous months migraines and mesnstrual cycle showing migraines on or between 2 days before or 3 days after the start of a menstrual cycle.
Treatment of menstrual migraine
Menstrual migraine is often treated with common migraine medications like non steroidal anti-inflammatory drugs, and sumatriptans. Some Doctors may time these medications to be started 3 days before the start of a period, in the hope of preventing the migraine attack Other medications used are the contraceptive pill and hormone supplements like oestrogen patches. Menstrual migraine is one of the most severe types of migraine and also the most resistant to migraine medication.
Our Approach
It makes sense that if neck pain or stiffness is a symptom you experience in association with menstrual migraine, then have your upper cervical spine assessed by a skilled practitioner to ‘rule in’ or ‘rule out’ your neck as a cause of your migraines. Our approach involves finding the neck segments responsible for this sensitisation, treating them, and desensitising the brain stem for long term relief.