Melanie was having headaches three times per week. After seeing Dr Teixido and Kelley Lester- Garrett RNP, she became aware of diet choices she was making that were causing headaches. After eliminating just a few foods the only headaches left were occurring at the time of her menstrual period. Although happy with her progress, she was frustrated that additional dietary changes did not eliminate her cycle-related headaches which are the most severe. With some preventive medications, these have now been controlled.
Melanie is not alone. “Migraine occurs three times more commonly in women than in men because headaches are triggered by hormone changes which occur frequently in women”, explains Kelley Lester-Garrett RNP. “Women’s hormones change at puberty, with monthly cycles, with pregnancy, at menopause and with the use of therapeutic hormones for birth control or for other reasons. 60% of women with headaches also suffer attacks related to their menstrual cycle.”
“Only 10% of women have headaches only with menses. Therefore, in most women, hormones are just one of many migraine triggers that need to be controlled to achieve headache–free living. Menstrual headaches require special treatment strategies in addition to the standard strategies of trigger identification and avoidance, and the use of medications to prevent or treat attacks. If the attacks are predictable, short-term preventive therapy can be started one to two days before the anticipated headache. Non-steroidal anti-inflammatory agents can be used for a few days around the period and help reduce headache pain as well as menstrual cramps. Stabilization of hormones may also benefit the migraines. This may include an estrogen patch or estrogen pills taken the week of the period. Daily attack aborting medications taken around the period may also reduce the headaches. Switching to a long cycle oral contraceptive is a good strategy for some. It can reduce the menses and associated headache problems to only four predictable times per year.”
“As women near menopause, the estrogen levels may fluctuate more and trigger an increase in migraines. Daily preventive therapy may again be necessary if the headaches are frequent and the periods are unpredictable. Women who go through natural menopause may have fewer headache problems than women having hysterectomies. In menopause, the use of continuous estrogen replacement without any days off helps to minimize migraine for many women. The dose should be the lowest effective dose. Dr Teixido and I always try to minimize the dosing of medications to minimize side effects for our patients.”
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