BENGALURU: Migraine is the most common primary headache disorder seen in clinical practice. A migraine is characterised by recurrent headaches that are moderate to severe in intensity. Typically, the headaches that affect one half of the head, are pulsating or pounding in nature, and last for few hours to days and sometimes up to 72 hours. Headaches may be associated with nausea, vomiting, and sensitivity to light, sound and smell. Headache increases with physical activity.
One-third of people have a short period of visual disturbance called visual auras that signals that the headache will soon occur. But these auras are less common in women with menstrual migraines.
Migraine is the most common issue in reproductive-age women. Menstruation is the most potent trigger of all migraine triggers. Migraine is two to three times more common in women than men and probably due to effect of hormones. Peak migraine prevalence in the women occurs during the early 40s and some studies suggest 41 per cent of women would have experienced migraine by the age of 50 years.
A decline in the estrogen concentration is the most important factor in triggering migraine in women. Natural decline in estrogen levels occur during beginning of menstrual cycle and following delivery (postpartum period). Withdrawal of estrogen containing pill (oral contraceptive pills) during hormone free intervals can also trigger migraine attacks. Women with endometriosis are more likely to suffer from chronic migraine and migraine related disability.
Pure menstrual migraine refers to migraine headaches which occur in close temporal relation to menses. Usually headache occurs two days before start of menses or after two or three days after onset of menstrual cycles. Menstrually related migraine refers to migraine associated with menses in a women who experience migraines at other times too.
Migraine is also very common during the perimenstrual period, which is also characterised by marked fluctuations in the estrogen levels. After menopause, the prevalence of migraine falls by 50 per cent, at least partly due to hormonal stability. So women who enter menopause with menstrual migraine tends to improve. The author is the senior consultant, epileptologist & neurologist, Sakra World Hospital
Complications due to migraine
Migraine can often lead to depression and anxiety, concentration and memory problems. It also has a risk of gastritis and renal failure due to overuse of pain medications. Certain pain relievers may cause abdominal pain, bleeding, ulcers and other complications, especially, if taken in large doses or for a long period of time. There could also be an increase in the risk of sleep issues, hypertension and stroke. Medication Overuse Headache (MOH) – taking over-the-counter or prescription headache medications for more than 10 days a month for three months or in high doses may trigger serious medication-overuse headaches. Medication – overuse headaches occur when medications stop relieving pain and begin to cause headaches.
Prevention of migraine
Avoid food and food additives that cause migraines such as red wine. Proper sleep and food can reduce the occurences of migraine. It is advisable to take preventive medications in case of complicated migraine, when it occurs for more than four times in a month and if the pain last for more than 12 hours.
Causes of migraine
Causes of migraine are not clearly understood. However, genetics and environmental factors appear a great role in developing the complication. It is also caused due to chemical imbalance in the brain.
Abortive or preventive treatment
Treatment for menstrual migraine includes abortive treatment during acute attacks. Preventive treatment is suggested if it doesn’t help. Prevention includes lifestyle modifications (healthy sleep habits, avoiding skipping meals) and medications. Medications called triptans (preferably long acting) can be started in women who prefer non-hormonal treatment at least two days before anticipation of menses and continued for five days. For women with menstrual migraine who require contraception can be managed with estrogen-progesterone containing pill in an extended cycle or low dose estrogen during the withdrawal phase. For a women who experiences migraine in the mid cycle period, low dose estrogen containing pills can prevent menstrual migraines.