Menstruation and Migraine

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Migraine, is a genetic, neurological disease that is the 12th most disabling disorder in the United States. Approximately, 37 million Americans have Migraine and of those, 50% – 60% of women have menstrual Migraine. If my math is correct, that means between 18 and 28 million women have some type of menstrual Migraine. That is a tremendous amount of women. When I began my research for this piece, I was surprised to find there wasn’t an abundance of information out there. It seems that Migraine and menstruation is not a hot topic.

I find these numbers startling, so I thought I would do a bit of comparison. This information is not meant to offend, rather inform. According to the American Cancer Society, 39,520 women will die from breast cancer this year and is the second leading cause of cancer death in women. Women have a 1 in 8 lifetime chance of having invasive breast cancer and a 1 in 35 chance of dying from breast cancer. Currently there are 2.5 million breast cancer survivors in the United States. Clearly, the numbers for Migraine are much higher than that of breast cancer, upwards of 18 million women have menstrual Migraine. A breast cancer survivor told me once; she would rather have breast cancer than a chronic illness because she knew there would be one of two outcomes: remission or death. Further, she felt living with chronic pain every day was not a conceivable option for her. My point is this, seeing as so many women have menstrual Migraine and Migraine in general, why is there so little research. Do I dare ask if it is a gender issue? If it were a men’s issue, would we have better treatments available to us?

According to the International Headache Society’s Classification of Headache Disorders, 2nd edition (ICHD-II,) there three types of Migraine associated with menstruation; pure menstrual Migraine without aura, menstrually-related Migraine without aura and non-menstrual Migraine without aura. The ICHD-II is typically the gold standard doctors use to diagnose Migraine and headache disorders.

Pure menstrual Migraine without aura are attacks similar to Migraine without aura, but happen during the first day or two before or after a woman menstruates – only – and at no other time of her cycle. This must be consistent for at least two out of three cycles.

Menstrually-related Migraine without aura – is similar to pure menstrual Migraine BUT Migraine can occur at other times during the month.

Non-menstrual Migraine – attacks that fit the criteria for Migraine without aura, but doesn’t fit into menstrually-related Migraine or pure menstrual Migraine and occurs in menstruating women. Migraine without aura includes but is not limited to the following symptoms:

• Attack lasting at least 4-72 hours which is untreated or unsuccessfully treated

• Moderate to severe pain • Increased pain with activity

• Unilateral location –but can be bilateral

• Nausea and/or vomiting

• Sensitivity to light and sound (photophobia and/or phonophobia)

• Not attributed to another disorder

It can be confusing at times to navigate through the various types of Migraine and/or headache disorders we have. Education and information are imperative in a patient’s health care regime.  Having a doctor who will work with us as a partner in our health care is essential.    Next time, how do we treat menstrual Migraine?

Resources: Brandes, Jan Lewis, M.D. “The Influence of Estrogen on Migraine: A Systematic Review.” The Journal of the American Medical Association.2006 ; 295 (15)1824-1830   Breast Cancer Overview.  How Many Women Get Breast Cancer. American Cancer Society. Last revised November 18. 2011.


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