Breaking the Silence: Menstrual Migraine
Photo: Liza Summer / Pexels
The difference between migraine and menstrual migraine
A migraine is a headache that can cause severe pain or a pulsing sensation. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Now that we understand what is a migraine it is going to be easier to define what is a menstrual migraine. In understandable terms, this is referred to as a migraine that is associated with menstruation.
Despite the simplicity of this definition, there is a harder task, which is understanding how and why it is produced.
Statistics
Migraine affects more women than men, the reason is that this condition is linked to hormonal changes.
Menstrual migraine affects about 20–25% of females who suffer regular migraines in the general population.
More than half of women with migraine report their periods as a cause that triggers their migraine attacks.
Understanding Menstrual Migraine
A migraine is a disorder that typically involves many genes with multiple causative variants of these. Each one contributes to a small effect size while also interacting with several environmental and life-style factors. Let’s think about these factors as dominoes:
Those who are diagnosed with a menstrual migraine or a perimenstrual* migraine attack, are associated with greater disability than their non-menstrual attacks.
* at the time of the menstruation, could be before or after.
The world of Hormones
What is a hormone?
A hormone is a chemical substance in the body that is produced and secreted to the bloodstream, to indicate to other cells, organs and systems a determined task that they need to do.
What controls hormones?
The endocrine system. This system uses hormones to control and coordinate your body's internal metabolism, reproduction, growth and development. Some of them are prepared to respond to injury, stress, and environmental factors.
What produces a menstrual migraine?
Remember when we said there is still not a defined mechanism of how this condition happens? Well, it is not that we do not know. There are a couple of theories around this, but it is still quite unsure to affirm that a single thing triggers these attacks.
There are two mechanisms that have been studied to the association of menstrual migraines:
Oestrogen withdrawal
Prostaglandin release
Why is this important?
Well, oestrogen plays a role in ovulation and thickens the endometrium, which is the inner layer of the uterus, and prostaglandins are the ones that produce cramps during your period.
If oestrogen levels plummet before your period starts, it is likely to be linked to a menstrual migraine. Women who have heavy and painful periods have higher levels of prostaglandins.
But do not get mad at your prostaglandins, they are just working to protect you, but that is a story for another time.
Although these theories have been studied, unfortunately, the evidence is not robust yet, and more research investment is needed to expand the understanding of how this condition is produced to develop more effective treatment strategies.
Can menstrual migraine be diagnosed and treated?
Unfortunately, menstrual migraine has not been deeply researched. However, studies show that an easy way to be diagnosed with it, the migraines should have an occurrence between two days before and up to three days into your menstruation, and they should be present at least in two out of three consecutive menstrual cycles.
As every other migraine, it can be treated. Nonetheless, most of the medication available is going to be useful during the attack instead of preventing it. But remember to always consult your gynaecologist or general practitioner for assessment and treatment.
Embrace yourself
Now you know, next time, take a deep breath. Menstrual migraine is a common condition that unfortunately is still not well understood and therefore, recognised.
It is often associated with considerable disability, so do not feel bad if you have experienced this terrible condition, as all this has a physiological explanation.
You are not alone, if you have experienced some of these symptoms during your period, remember to always consult your doctor.
BibliographyMenstrual Migraine: A Distinct Disorder Needed for Greater Recognition; K. G. Vetcik; E. A. MacGregor; Lancet Neurology (2021); Available in: https://doi.org/10.1016/ S1474-4422(20)30482-8 Menstrual Migraine; The Migraine Trust; Available in: https://migrainetrust.org/understand-migraine/types-of-migraine/menstrual-migraine/#page-section-2 Treatment of Migraine Attacks and Prevention of Migraine: Guidelines by the German Migraine and Headache Society and the German Society of Neurology (2018); H. C. Diener; T. Dresler, D. Holly-Lee, et al; Available in: https://ihs-headache.org/wp-content/uploads/2020/06/3426_dmkg-treatment-of-migraine-attacks-and-prevention-of-migraine.pdf