The female “I have a headache today” can be a symptom of a real disease, and not just an excuse as an evasion of any obligations or a topic for another joke. And there is a medical explanation for this: migraine suffers mostly from the female population of the planet, and a headache that occurs systematically during menstruation or a few days before its onset is classified as menstrual migraine (catamenial migraine).

Migraine and the menstrual cycle

Migraine and the menstrual cycle

The menstrual cycle is the monthly changes in the body of a woman of reproductive age that occur under the influence of hormones and are aimed at the possibility of conceiving and bearing a child.

Regularly, a woman has to experience a number of unpleasant symptoms associated with menstruation — from abdominal pain, heaviness in the legs, mood swings to migraine attacks. About 14% of women find that migraine overtakes them directly on the days of menstruation. Studying this interesting pattern, the International Classification of Headache identified special criteria for menstrual migraine:

  • Menstrual migraine

A migraine attack appears in the perimenstrual period (two days before or 3 days from the onset of menstruation).

  • Menstrual associated migraine

Attacks appear both in the perimenstrual period and on other days of the cycle.

Moreover, the occurrence of migraine attacks should be registered in at least two cycles out of three.

For a long time there were many gaps in the pathogenesis of this pathology. Over time, medical research has led to a consensus: the cause of this type of headache lies in hormonal fluctuations that constantly occur in the female body and are a physiological norm — menstruation, ovulation, lactation, childbirth.

Causes of migraine in hormones

The idea that the direct cause of migraine in women is female sex hormones was suggested by the facts obtained in the study of the prevalence of the disease among men and women. It turned out that in childhood and old age, both men and women suffer from migraine in approximately the same proportion. However, in reproductive age (30-40 years), women get sick 3 times more often than men. With the onset of menopause, this figure decreases again and almost balances out. This suggests that the occurrence of migraine is closely related to fluctuations in the level of female sex hormones in a woman’s body.

Estrogens are prime suspects in migraine development

The occurrence of headache during menstruation was noted by Hippocrates. Doctors and scientists have been studying this phenomenon for a very long time. Some time ago, it was revealed that the main «culprits» of menstrual migraine are female sex hormones — estrogens produced by the ovaries.

The development of menstrual migraine is affected not by the quantitative level of estrogen in the body of a woman, but by fluctuations, the so-called “jumps” towards a sharp decrease. Similar «jumps» can be found at different periods of a woman’s life:

  • Before and during menstruation
  • During ovulation
  • After childbirth
  • When using combined oral contraceptives, namely, during a seven-day break
  • After the removal of the ovaries

The above events in a woman’s life are risk factors for the development of menstrual migraine.

Well, how are hormones capable of causing a headache? The fact is that estrogens can affect neuronal excitability and pain transmission in those parts of the brain that are activated during a migraine attack.

There is also an assumption that over time, hormones can form persistent changes in the brain, which is explained by the persistence of migraine attacks in menopause.

Symptoms of a menstrual migraine

Symptoms of a menstrual migraine

Menstrual migraine is characterized by the severity of symptoms, namely:

  • Headache is more intense than non-menstrual migraine
  • Headaches last longer
  • The woman’s well-being suffers more, the ability to work is significantly reduced
  • Symptoms such as nausea, vomiting occur
  • Menstrual migraine is more difficult to treat with medication

The severity of symptoms is also affected by the day of the cycle when the attack occurred. So, a migraine that developed 2 days before the onset of menstrual bleeding proceeds with a greater intensity of headaches (about 2 times) than a migraine that developed in the first days of menstruation. And in relation to a migraine that is not associated with the menstrual cycle, it is 3 times more intense.

Prevention and treatment of headache

Menstrual migraine should ideally be treated by two specialists — a gynecologist and a neurologist.

The therapy includes two tasks:

  • Relief of an already occurring attack
  • Prevention of subsequent attacks

Treatment is carried out according to the same principles as in cases with non-menstrual migraine, but has its own characteristics. They are associated with the fact that the symptoms of menstrual migraine are more pronounced and longer, and the disease is more difficult to respond to the usual anti-migraine drugs.

Therefore, it is preferable to immediately start treatment with a modern group of drugs — triptans (sumatriptan, rizatriptan, zolmitriptan).

Prevention can be permanent or short term.

Permanent prevention involves the use of hormonal drugs, antidepressants, anticonvulsants for a long time. This method is suitable for people with irregular cycles.

For short-term (mini) prophylaxis, anti-migraine drugs or hormonal agents are prescribed a few days before the onset of menstruation for a period of 5-7 days.

A woman with recurrent headaches should keep her own diary, write down her pain sensations in it and mark the days of the cycle when headache attacks appear and when they end. This will help the doctor in making a diagnosis and drawing up a treatment plan, since it is not always possible to reliably remember the beginning of an attack and the day of the cycle.

Clinical Neurology / Nikiforov A.S., Gusev E.I. 2007

Endocrinology / Ed. Dedova I.I., Melnichenko G.A. 2013