MENSTRUAL MIGRAINE

Menstrual migraine is more severe than migraine attacks seen in other periods and is also more resistant to treatment. Menstrual period is an important trigger especially for migraines without aura. Due to hormonal changes, it occurs most frequently two days before menstruation and on the first day of menstruation. Correct diagnosis of menstrual migraine is important for determining the treatment strategy. In order to call migraine attacks related to menstruation, there must be migraine attacks without aura in at least two of the three menstrual periods, 2 days before and 3 days after menstruation. For this purpose, a headache diary should be kept for at least 3 months, the relationship of migraine attacks with menstruation should be clearly determined and the treatment strategy should be planned accordingly.

TREATMENT IN MENSTRUATION MIGRAINE

Non-drug Measures

In menstrual migraine, as in other migraine attacks, it is necessary to take measures to reduce attacks. It is necessary to pay attention to sleep patterns, stay away from foods that trigger migraine attacks and alcohol intake, and avoid bright lights and strong odors. It is necessary to be careful especially about birth control drugs and hormone use.

Attack Treatment

Similar drugs to other migraine attacks that occur during menstruation are used. Simple painkillers or migraine-specific painkillers (triptans) used during this period should be taken as soon as possible after the attack starts, depending on the severity of the attack.

These are treatments that are started 2 days before the menstrual period and continued for the first 3 days of the menstrual period.
Since the date of the start of menstruation is important in this treatment plan, it can only be considered in women with regular menstrual periods. In cases of irregular menstruation, the date of starting the medication can be determined by measuring daily body temperature.

While drugs used in migraine attack treatment can be used, drugs in the form of skin patches and gels can be used to control estrogen fluctuations.

Long-Term Preventive Treatment

Hormone treatments can be used in the long-term preventive treatment of menstrual migraine, in addition to the classical drugs used for the preventive treatment of migraine. For this purpose, drugs containing different doses of estrogen, which can be applied orally or through the skin, can be used. Although less frequent, intrauterine progesterone applications may also be preferred. The aim of continuous hormonal treatment is to suppress the activity of the eggs and create a regular hormonal balance. However, it should be noted that hormone treatment increases the risk of cerebrovascular disease, especially in those with migraine with aura, smokers, older people, and those with risk factors.