Introduction to Women's Issues in Migraine
The link between migraine and female sex hormones is well established. In prepubertal children, the incidence of migraine is equal in boys and girls. However, with menarche and throughout childbearing years, the incidence of migraine in women becomes two or three times that of men. Migraine may be affected by menstrual cycles, pregnancy, oral contraceptives, menopause and hormone replacement therapy. There is an overall decline in the post menopausal period. 1
Migraine and the Menstrual Cycle
Among many other well recognized triggers, menstruation is a very definite trigger. Menstrually associated migraine (MAM) occurs in up to sixty percent of female migraineurs. True menstrual migraine occurs in fourteen percent with the headache occurring exclusively at the time of menses. The true definition of menstrual migraine is not widely accepted, although there is agreement that menstrual migraine can occur prior to the onset or during menstruation. Generally accepted criteria are not available. 1
Both riboflavin (400mg/day) and magnesium (360mg/day) have been used with some success and may be worth trying in women who prefer a nutraceutical treatment. - Dr. Rose Giammarco, M.D. FRCPC, McMaster University, Hamilton, Ontario Headache Clinic
Hormones and the contraceptive pill
It is important to mention that headaches are a common side effect of taking oral contraceptives and in that case usually improve over time. They can be affected by the dose and type of hormone in the pill. Some women find that their headaches and migraines improve when they start the pill. Other women notice that their headaches and migraine get worse. Studies suggest that headaches are less likely to occur with the lowest dose pills (20 micrograms of oestrogen) containing newer types of progestogens but this is not the same for everyone. It is important to find the pill that suits you best. 2
Migraine and Menopause
In women with migraine linked to their menstrual cycles there will likely be an improvement in their headaches in postmenopause. However, in the perimenopausal years there will likely be an exacerbation in their headaches before they improve. Once again, abrupt fluctuations in estrogen levels during the perimenopause are felt to be responsible for the change in headache pattern. With the more stable low estrogen following menopause, the tendency is that migraine may improve. 3
Migraine and Pregnancy
Migraine may be affected in a variety of ways by pregnancy. They may increase, diminish, or remain unchanged. Headaches may also appear for the first-time during pregnancy, usually during the first trimester, and typically subside in the second and third trimesters.
Often migraines began with menarche and are linked to menses and the sufferer may experience relief of headache during pregnancy. 4
Breast-feeding (not a trigger)
Many women with migraine are concerned about taking medications while breast-feeding, exposing the child or unborn fetus to medications. However, many medications can be safely taken during breast-feeding including acetaminophen (Tylenol), anti-inflammatory medications such as ibuprofen (Motrin) and naproxen (Aleve), and sumatriptan (Imitrex).
If you breast- feed your baby it is still best to avoid medication as much as possible because the baby will be taking whatever you take through the milk. The same drugs used in pregnancy can be taken whilst breast-feeding with the exception of aspirin. The aspirin which enters the breast milk could impair blood clotting in susceptible babies and so is best avoided.
If you need to take aspirin or other non-recommended medications such as the anti-sickness drug metoclopramide, whilst you are breast-feeding it is best to not breastfeed for 24 hours after the last dose. Ideally, keep some expressed milk in the freezer for such occasions; otherwise you will need to give formula milk. Although you may feel too unwell to do so, it is best to express milk at the usual feeding times but this will need to be thrown away. This can help ease discomfort as the breasts become engorged with milk and will help to prevent milk. 5
- Lay, C Women's College Hospital for Headache, Toronto, Ontario
- The Migraine Trust, managing migraines, women's issues
- originally written by Dr. Christine Lay, reviewed by Dr. Rose Giammarco, Hamilton, Canada 1998
- Giammarco, R - Pregnancy and Headache
- McGregor, A breast-feeding and migraine, 1998