What do I do about menopausal migraines?

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Dear Ellen,

I came across your info while listening to you on Doctor Radio.
Anyway, I have been suffering from migraines that I believe are due to my peri/menopausal symptoms.  I had one yesterday that was very painful and derailed my entire day.
My question is, will my migraines subside when I am 100% in Menopause?  My last blood work in February, my Dr. said I was “in menopause”.
Thank you.

All the best, Lynne

Dear Lynne,

You are not alone!  Many women are having this very same issue.  To help find some answers, I interviewed Dr. Susan Hutchinson, director of the Orange County Migraine & Headache Center in Irvine, California. Dr. Hutchinson told me that about 13 percent of adults in the United States suffer from migraines—that’s 35 million people and that 27 million of those migraine sufferers are women.

Migraines, unlike other headaches, are often hormonal in nature, so intense fluctuations of hormones (especially estrogen!) in women can egg on and worsen migraines. (My daughter is pregnant with our first grandchild and has suffered from migraines during her entire pregnancy.) The silver lining is that two-thirds of female migraine sufferers completely ditch their migraines or notice marked improvement when they enter menopause, a time in which hormones finally stop fluctuating. In fact, after age 60, only 5 percent of women suffer migraines, according to the Migraine Research Foundation.

Here are some helpful tips for managing your migraines:

Find a Specialist
As with most things medical, visiting a trained specialist is a solid first step. Your perimenopause and menopause specialist can evaluate your migraines in relation to your hormonal status.  You may find that you need hormone replacement therapy or if you are already on HRT, you may need to have it adjusted. If you find that your HRT is not doing the trick it is time to find a good headache and migraine specialist who is versed in how fluctuating hormone levels affect migraines. Your best bet? Ask your perimenopause and menopause specialist for a referral or look for local M.D.s on headaches.org or achenet.org.

Consider Non-Oral Bio-Identical HT (hormone therapy)
Whether you are on hormone replacement therapy or are just thinking about taking the plunge, talk to your perimenopause and menopause specialist about how HT can influence perimenopausal migraines—both for good and for bad. Remember: “All forms of HT are not created equal,” Dr. Hutchinson says. “If HT is used, the general consensus in the ‘headache world’ is to use a non-oral delivery system such as the estradiol transdermal patch. It would be expected to help prevent migraine as it provides an even level of estradiol and is the same chemical structure as the estrogen/estradiol that a woman’s ovaries produce prior to menopause.” On a synthetic, oral pill? It might actually be worsening your migraines! “Oral preparations have more variability in absorption and blood levels and therefore would be predicted to not be as helpful in treating/preventing menopausal migraine. Synthetic and oral preparations are more likely to cause or aggravate headache,” Dr. Hutchinson says.

Fight Your Triggers
Apart from hormone fluctuations, bright or flashing lights, a lack of food or sleep, and stress can all contribute to migraines, according to the North American Menopause Society. Your best defense is good self-care. Dr. Hutchinson advises eating small, frequent meals throughout the day that pack both complex carbohydrates (think: whole grains, legumes, and starchy vegetables) and protein to regulate blood sugar levels. Dietary supplements including butterbur, B-2 (riboflavin), co-enzyme Q-10, and magnesium can also be helpful in migraine prevention, according to Dr. Hutchinson. Make sure to drink plenty of water, as dehydration can cause headaches. Remember: if you feel “thirsty,” you are already dehydrated, according to the National Health Service. Getting a full night’s sleep and exercising regularly (which can help you sleep better!), can also help. Last but not least, don’t smoke! You also might want to cut back on the caffeine and booze, she says.

Don’t let perimenopause and menopause be a pain—figuratively or literally! A happy head is vital to being the productive and fulfilled women that we are destined to be.

Good Luck!  Keep me posted!

Hugs,

Ellen

Remember: Suffering in silence is OUT! Reaching out is IN! 

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.