Headaches and your period

Many women are hit by headaches related to their menstrual cycles. Some are minor niggles, but some are major migraines.

In the case of the latter, women are twice as likely to experience migraine during the first two days of their menstrual cycle than during the rest of the month, according to research reported in Neurology, the scientific journal of the American Academy of Neurology.

The study also found a higher risk of migraine in the two days before menstruation begins, as well as a lower risk around the time of ovulation.

A good move for sufferers would be to monitor migraines and headaches. "If women have a better idea when they'll get a migraine during their cycle, they have a better chance of preventing or treating it," said Stephen Silberstein, MD, a neurologist and director of the Headache Centre at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.

The study looked at the relationship between migraine and menstruation in the general population. It is also one of the first studies to ask if migraines during menstruation are different in their length and pain than during other times.

The results showed 28% of migraine without aura, the type of migraine most often associated with menstruation, took place in the four days surrounding the beginning of menstruation. There was also a greater chance of tension-type headache. However, there was no increase in migraine with aura or any evidence to support the idea that migraines during menstruation are more painful or more severe.

Previous studies have looked at the relationship between migraine and menstruation in patients at headache clinics. Migraine develops most often around adolescence, and researchers have looked at its relationship with the cyclic changes in female sex hormones. Research has shown that the primary trigger for migraine during menstruation may be the withdrawal of oestrogen.

What to do

• Keep a headache diary – this may help you identify triggers. When a migraine occurs, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.
• Because some migraines are caused by falling oestrogen levels it may be beneficial to elevate your hormonal levels says Dr Brian Grosberg, assistant professor of neurology and director of Inpatient Headache Program at Montefiore Headache Centre in New York City. "Boosting oestrogen levels in small doses starting five days before menses may decrease or prevent severity of the attacks."
• Speak to your doctor about non-steroidal inflammatory medications as well as migraine-specific medications known as triptans.

Supplements

The University of Maryland's Medical Centre reports on several complementary therapies:

• Magnesium (200-600mg per day): People with migraines often have lower levels of magnesium compared to people who do not have migraines. Studies suggest that magnesium may reduce the frequency of migraine attacks. Some studies also suggest that magnesium may be specifically helpful for women whose migraines are triggered by their periods.
• 5-hydroxytryptophan (5-HTP, 400-600mg per day): Researchers think abnormal serotonin function in blood vessels is related to migraines, and some of the drugs used to treat migraines work by affecting serotonin. Several studies indicate that 5-HTP may be about as effective as some prescription migraine medications, reducing the intensity and frequency of attacks. However, more studies are needed to be sure that 5-HTP is helpful in treating migraines. If you take an antidepressant, or supplements such as St John's Wort, you should not take 5-HTP.
• Change your lifestyle and you may change your life. Avoid cigarettes, caffeine, and alcohol. Exercise regularly, get enough sleep, eat well and try and reduce stress.
• Once a headache or migraine hits rest in a quiet, darkened room and drink fluids to avoid dehydration (especially if you have vomited).

(Updated by Robyn von Geusau, Health24, February 2011)