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peri-menopause and menopause and #migraines

I am not old enough for menopause but I do get hormonal related migraines so it is interesting to know what I will be in for. Pre-menopause and menopause can be extremely hard years of migraineurs. Depending on the woman the perimenopausal years can start in the 40's and menopause in the 50's. The increase "migraine frequency may occur because of an increase in trigeminal nerve sensitivity to falling estrogen levels." Seven portions

Research done in 2011, and I have had this confirmed by personal stories as well, suggests that hysterectomies do not help bypass this either. Going through it naturally seems to have a better likelihood of reducing the migraines after it is all said and done. But... "Both results are conditional though, depending greatly on whether or not a woman’s migraines earlier in life were closely related to her menstruation. If a woman experienced menstrual migraine or menstrually-related migraine as her most severe migraine each month, then the results of this study might apply. However, if her worst migraines occurred as a result of non-hormonal factors, the transition into menopause may have no effect." Seven portions

And you have to love this:

According to a June 2009 article published in Post Reproductive Health, the recommended treatment for management of menstrual migraines in perimenopause is HRT. Yet according to Dr. Ralph Evans in Handbook of Headache, the use of HRT has a 45% of reducing the number of attacks and almost an equal chance (46%) of making them worse. Seven portions
However, this is not unexpected. The treatment for menstrual migraines that is hormonal treatments can make it better... or make it worse. But this? Basically 50-50 shot there.

Alternatives are:

Taking NSAIDs for three days prior to the start of menses and continuing through the cycle can sometimes prevent menstrual migraines. Others have success with using long-lasting triptans daily for the same duration. Magnesium supplementation may also be effective. If non-hormonal treatments fail, HRT may still be considered. The best hormone replacement results (33% improvement) appear to be from more natural forms of estrogen such as a patch while conjugated estrogens (Premarin) tend to make migraines worse.  Seven portions
Now these are similar to menstrual migraines so all sounds the same here. A little warning on the NSAIDs though. I tried this for menstrual migraines and it gave me a bleeding ulcer. Cramps, pain and then bleeding ulcer. Doctors are quite comfortable prescribing NSAIDs but they also have their side effects and it is good to remember that. Also in my case my reaction to them, which was painful from the get go and got worse, caused a permanent drug sensitivity so I cannot even touch OTC NSAIDs any more. Which as you can imagine sucks because they are rather nice for menstrual migraines and symptoms. I had been given this option because I have bad triptan side effects so cannot take them continuously, which as stated is another option. I believe Amerge had been mentioned to me as a good one.

Since menstrual migraines are the most brutal and acute migraines of them all, and very difficult to treat I cannot image peri-menopause and menopause are going to be fun in the least.

Sources to check out

  1. Women with migraine experience more headaches during the menopausal transition: results from The American Migraine Prevalence and Prevention (AMPP) Study
  2. Hysterectomy and Migraine: What can you expect?
  3. Migraine outcome in postmenopausal women: are there predictive factors? 
  4. Hormonal management of migraine at menopause
  5. Medical Oophorectomy With and Without Estrogen Add-Back Therapy in the Prevention of Migraine Headache
  6. Headaches Increase During Perimenopause
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