Treating menstrual migraines with hormones

Women with menstrual migraines who also have chronic migraines can be successfully treated with hormonal therapy, according to a study by Drs. Calhoun and Ford published in journal Headache.  Surprisingly, controlling menstrual migraines led to improvement in chronic migraines as well.  Chronic migraine is defined as a headache with migraine features that occurs on more than 15 days each month and it affects a staggering 4%-5% of the population.   Hormonal therapy usually consists of taking an oral contraceptive continuously for many months, thus eliminating menstrual periods and often headaches and PMS symptoms.  Oral contraceptives should not be taken by patients who have visual aura – visual disturbance that usually lasts 30 minutes and precedes the headache.

13 comments
  1. Dr. Mauskop says: 12/06/201911:39 am

    There have not been any recent studies, but the existing evidence suggests that continuous contraception can be effective. The risk of strokes is very low, especially in those who have migraines without aura, unless there are other risk factors for strokes.

  2. Marie Webster says: 12/05/20194:24 pm

    Have there been any follow up studies on continuous oral contraceptives and chronic migraines? I have chronic migraines that have been very resistant to the usual preventatives (including Botox and Aimovig), and I’m considering continuous oral contraceptives. My husband had a vasectomy so migraine relief would be the only reason to try it! Thanks.

  3. Dr. Mauskop says: 07/10/201912:56 pm

    You are right – progesterone usually does not make headache worse and does not increase the risk of strokes (although the increase in this risk is low even for estrogen). The increase in pressure in the brain from Mirena is very rare, so it is not something we warn patients about.

  4. Maria says: 07/08/201911:50 am

    Do you have any thoughts on progesterone only IUD’s? My gynecologist recommended Mirena to treat menstrual irregularities and endometriosis. My understanding is that progesterone only contraceptives are safe for migraneurs, although they won’t improve the migraines. However, when you google Mirena, the first link you see is about a lawsuit for increased pressure in the brain, etc and contraindicated for migraneurs. Any thoughts about this would be helpful. Thank you,

  5. Dr. Mauskop says: 01/28/20171:04 pm

    Yes, I’ve seen a number of women whose migraines stopped after having a baby and not always the first one. Hormonal factors are clearly very important since most women start having migraines at puberty and 2 out of 3 stop having them after menopause. In most women migraines stop during pregnancy only to return with the resumption of periods. Sometimes relief comes from continuous contraception – taking a pill without a monthly break. Menstrual migraines can be more severe than non-menstrual ones and some patients even ask about having a hysterectomy. Unfortunately, unlike natural menopause, hysterectomy does not stop migraines. A study of hysterectomy for migraines was done at the Mayo Clinic in the 1940s and it was negative. Obviously, these days such a study would not pass the ethics board review.

  6. Lesley says: 01/27/20174:44 pm

    When I was 24 years old, I began suffering from migraines. My father and paternal grandmother suffered from them too, so I figured it was hereditary. During my 30’s I experienced 8-16 migraines each month which hurt my work and social life. I would stay in bed for 24 to 48 hours in pain even when using medication prescribed by my doctor/neurologist.

    Since having my first child at the age of 42, I have been migraine free. After having my baby (who is 4 years old now) my eyesight improved, my migraines went away and I don’t get cold. I rarely need a sweater or extra jacket. Overall my body temperature is higher and I can’t wear thick sweaters because I will sweat. And I am nowhere near menopause (my blood work proves it). I have had full panel hormone tests prior to getting pregnant and after so I can see the comparisons of my blood work.

    I am sharing this with you because I was on every prescribed medication for 18 years. I visited leading neurologists who could do little to help me. Finally, after having a baby I was healed. I wonder if you have heard of this before? Is there a way to change the body chemistry/hormone levels to help others be migraine free? I think my hormone levels are different now after having a baby than before giving birth. Obviously, not everyone can give birth, but can we flip a switch in people’s body chemistry/hormone balance to make them migraine free?

  7. Earlene Erker says: 05/05/20113:05 pm

    The name Shiatsu is derived from Japanese from shi, meaning finger, and atsu, meaning pressure) is really a conventional hands-on therapy originating in Japan. You can find two primary Shiatsu schools; one based on western anatomical and physiological theory where it soothes an overactive sympathetic nervous program, improving circulation, relieving muscle tension and decreasing tension, and also the other based on a holistic program of Conventional Chinese Medicine (TCM).

  8. Dr. Mauskop says: 03/13/20104:49 pm

    It is not unusual to have migraines get better or worse after the birth of a child, but we do not have any evidence that tubal ligation makes headaches worse. With this procedure the ovaries continue to function normally and produce hormones which can trigger migraines. You may want to talk to your doctor about trying various treatments, including magnesium, triptans, Migralex, Botox injections, and continuous contraception.

  9. Lisa says: 03/12/20104:41 pm

    I started suffering from menstral migranes after the birth of my last child. I have met a couple woman who also started getting menstral migranes. The only thing we have incommon is that we both had are tubes tied. Could there be a connection?

  10. Dr. Mauskop says: 12/19/20089:25 am

    For some women taking a contraceptive the way most women take them – three weeks on and one week off – does help their migraines. However, for some, the pill makes headaches worse, which can also happen with continuous contraception.

  11. Luciana says: 12/19/20083:26 am

    I am curious to know if i take the contraceptive and stop to get my period normally,go back to the contraceptive.Could i still get rid of the migraine?

  12. Dr. Mauskop says: 09/16/20085:47 pm

    You can ask your gynecologist about taking Lybrel – an oral contraceptive you take continuously for a year. Hysterectomy does not cure migraines, but natural menopause usually stops them in two out of three women. Because you had no headaches during pregnancy you will probably stop having headaches after menopause.

  13. courtney says: 09/16/20085:25 pm

    how can i get more info on this? I suffer with migraines and menstrual migraines and am curious about post hysterectomy- would i still get them? i did not get any during both my pregnancies, but now get 8/month.

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