Sorting Out My Hormonal/Menstrually Associated Migraines

As the frequency of my migraine episodes has reduced this year, I was finally able to tell that I always get a migraine the first and second or third day of my period. Today once again provided confirmation.

My plan was to try hormonal birth control, like the pill, as a preventive. Researching this post has me reconsidering. Turns out women with migraine who use birth control pills are eight times more likely to have a stroke than women who don’t. This applies to everyone with migraine, not just those with aura (who are twice as likely to have a stroke than migraineurs who don’t have visual auras).

Other treatment options exist. Most of them I’ve already taken without success. Magnesium, which I think is responsible for decreasing the frequency of my migraines, is a common treatment. Unfortunately I’m already at the highest dose of magnesium I appear to be able to tolerate without extreme nausea.

I found on headache specialist Christina Peterson’s website that a small study of black cohosh shows it may be effective in treating menstrually associated migraine. Because there has only been one study, there is no confirmation that it works. Nonetheless, I’ll be researching black cohosh extensively. It is in the same family as rununculus, one of my favorite flowers — maybe that’s a sign it will help my head!

I thought hormonal birth control would be the ticket. A stroke would certainly be worse than having two more migraines a month.

If your migraines are associated with your menstrual cycle, please let me know if you’ve found an effective treatment. Leave a comment below or respond to the forum post with your suggestions.

Lower Risk of Breast Cancer for Women With Migraine

Finally, some good news for migraineurs. Women with migraine had a 30 percent lower risk of breast cancer than those without, according to a recently released study. Hormonal changes, which commonly trigger migraine, are a potential link.

In particular, migraine history appeared to reduce the risk of the most common subtypes of breast cancer: those that are estrogen-receptor and/or progesterone-receptor positive. Such tumors have estrogen and/or progesterone receptors, or docking sites, on the surface of their cells, which makes them more responsive to hormone-blocking drugs than tumors that lack such receptors.

The biological mechanism behind the association between migraines and breast cancer is not fully known, but Li and colleagues suspect that it has to do with fluctuations in levels of circulating hormones.

Clinical Trials for Treating All Sorts of Headache Disorders

ClinicalTrials.gov is the place to go if you’ve considered participating in a clinical trial for your headache disorder, These are just the latest in 142 headache studies recruiting participants or will be recruiting soon.

Nearly every headache disorder is represented: cluster, tension-type, post-traumatic, migraine, cervicogenic, lumbar-puncture, medication overuse (rebound)…. Treatments range from medication and surgery to diet, coping skills training, relaxation, meditation, yoga, exercise… Again the list goes on.

The diverse collection of current studies include:

Even if you’re not interested in any of these studies, checking the government’s clinical database regularly may turn up something new that works for you. Searching for “headache” gets the most results, but you can also search by specific headache type. For example, there are 74 active studies on migraine and seven on cluster headaches.

Migraine Linked to Blood Clots in Veins

People with migraine may be more likely to develop blood clots in their veins than those without, according to a study published today. Called venous thrombosis or thromboembolism, the blood clots can lead to strokes. Researchers speculate this is why people with migraine have a greater risk of stroke.

Studies of stroke and migraine implicate only people who have visual auras with their migraines. I wonder what migraine types the blood clot study participants had.

From Science Daily:

Of the [574] participants, 111 people had migraine. A total of 21 people with migraine also had one or more instances of venous thrombosis, or 19 percent. In comparison, 35 people without migraine had the condition, or 8 percent.

Researchers do not know why migraine and venous thrombosis are linked. One theory is that the blood of people with migraine may be more prone to clotting.

The study also found that people with migraine are not more likely to have hardening or narrowing of the arteries, which is contrary to a current theory.

Migraine and Gluten Sensitivity

In a desperate attempt to treat her migraines, herself (gluten-free) blogger Karen Yesowich Schmucker discovered she was sensitive to gluten. Adopting a gluten-free diet has reduced the frequency and severity of her migraines. Karen explains the connection in this guest post.

While there is data to suggest that a certain percentage of migraineurs also suffer from celiac disease or some form of gluten sensitivity, few neurologists routinely test their patients for it. One study done in Italy in 2003 suggested that 4% of migraineurs also had celiac. You may think this is a small number and that may explain neurologists’ reluctance to test for it. But consider this: few people in the general population are ever tested for gluten sensitivity or celiac disease. Until recently, doctors considered it to be extremely rare, but now there is reason to believe that the number of people in this country who have some form of intolerance to gluten is 1 in 133, or about 3 million. Over 90% of these people do not know of their gluten sensitivity. So how safe can we as patients feel about the small number of migraineurs who also have Celiac? We don’t really know how many of us are out there. Should we care? Would a gluten-free diet really help us? And what the heck is gluten anyway?

Gluten is a protein found in wheat, rye and barley. It is what makes dough from these grains sticky and hold together when baked. Gluten is also used in many other food products from soups and salad dressings to soy sauce and beer. Gluten intolerance is an autoimmune disease which, left untreated, will eventually destroy the villi in the small intestine, leading to malabsorption of minerals and nutrients. There are serious implications from malabsorption including osteoporosis, certain cancers and a host of other disorders. Go to the National Foundation for Celiac Awareness to find out more.

Today the only treatment for gluten sensitivity is the complete and lifelong avoidance of gluten. Does maintaining a gluten-free diet help migraine? There is some evidence to suggest that some migraineurs are helped by it. Some report the total disappearance of migraine while others have fewer and less severe attacks. I fall into the latter category. I found out (by accident) a little over a year ago that I am gluten intolerant and I have followed a gluten-free diet since December 2006. Do I still get migraines? Yes, but not as many and not as severe. I have not had a classic migraine (with aura) in about a year. Does my neurologist think that gluten caused my migraines? No, but it could have created a situation where migraine was more likely to occur, especially since I had evidence of malabsorption and was deficient in several important minerals like magnesium, even though I was supplementing at 400 mg per day!

As a direct result of my experience, my neurologist now tests his patients who show gastrointestinal symptoms for gluten sensitivity. But he doesn¹t test all his patients. He (incorrectly, according to experts on celiac) believes that one must have these types of symptoms before testing makes sense. However, with celiac, symptoms often do not appear until the disease has progressed and a patient is not absorbing nutrients. Here are some of the symptoms noted in celiac literature: fatigue, anemia, migraine, eczema, psoriasis, mineral deficiencies, as well as gastrointestinal complaints such as bloating, gas, constipation and/or diarrhea. So the bottom line is: finding out you have gluten intolerance may or may not help your migraine, but the health benefits of discovery and treatment by themselves are compelling. I went gluten-free hoping to rid myself of debilitating headaches, but knowing what I know now makes me glad I did it regardless of the effect on my headaches.

If you do decide to get tested, make sure you do NOT start a gluten-free diet until AFTER the test results come in and your doctor tells you to start it. The test will come back negative if you are not actively eating gluten. If you go on a gluten-free diet please give it a good chance to succeed. I found some of my symptoms disappeared within three days, but the migraine-easing part of it took longer. Months longer. So be patient and don’t cheat. It can take up to 18 months for your system to heal. If you want to see how to navigate life gluten-free, visit my blog. You can find recipes there as well as tips for managing eating out, traveling and otherwise living a normal life gluten and headache-free.

References and Resources:

  • Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Gabrielli, M.; Cremonini, F.; Fiore, G.; Addolorato, G.; Padalino, C.; Candelli, M.; de Leo, M.E.; Santarelli, L.; Giacovazzo, M.; Gasbarrini, A.; Pola, P. The American Journal of Gastroenterology, Volume 98, Number 3, March 2003 , pp. 625-629(5)
  • Migraine and Coeliac Disease. Headache: The Journal of Head and Face Pain 38 (8). J. Serratrice MD, P. Disdier MD, C. de Roux MD, C. Christides MD, P.J. Weiller MD.  (1998), 627­628 doi:10.1046/j.1526-4610.1998.3808627.x
  • Celiac Disease: A Hidden Epidemic. Peter H. Green, Rory Jones. HarperCollins Publishers. 2006. ISBN-13: 9780060766931 (Peter H. Green, M.D., director of the Celiac Disease Center at Columbia University. He confirmed that migraines can be a symptom of celiac disease.)
  • Living Gluten Free for Dummies. Dana Korn. Wiley Publishing, Inc. Hoboken N.J., 2006
  • All in Your Head. Untreated gluten sensitivity can affect your gut, your skin and your brain. By Alicia B. Woodward. Living Without magazine. Winter 2007. Pp. 11-16; 27.
  • Celiac Disease Foundation
  • Gluten Intolerance Group

Karen Yesowich Schmucker is a freelance graphic designer and translator who lives with her husband in Bellevue, WA. Karen also teaches Naginata (a Japanese martial art) near Seattle. A migraineur since age 12, she has been gluten-free since December 2006. Contact her at karen[at]kysdesigns[dot]com.

Eye Exam Findings

Thanks for all the recommendations and information. The appointment went well, but I’m waiting (rather impatiently) for my new contacts and glasses to come in. I have a new prescription, which should correct my vision better more than my current contacts. If my new contacts need fine-tuning, we’ll consider glasses to wear with them.

The optometrist suggested low-power reading glasses for reading or working on the computer for now. He said they’re basically magnifying glasses and do the focusing for your eyes, which lets the muscles rest. He also said the power is low enough that they can’t cause any harm. I could only keep them on for a few minutes while I was on the computer. I’ll see how they work for reading.

Reader comments on Using My Eyes is Triggering Migraines have great suggestions for dealing with this problem. I’m going to try some myself.

Headache Only One of Migraine’s Many Symptoms

More than half of people with migraine experience nausea, neck pain, or sensitivity to lights, sounds or smells during a migraine, yet few doctors regularly ask about symptoms other than headache. These findings, from a National Headache Foundation survey, include only a partial list of possible migraine symptoms.

Migraine Goes Beyond Head Pain
(National Headache Foundation press release)

Chicago, IL – August 13, 2008 – Migraine sufferers often experience a series of associated symptoms in addition to migraine head pain, according to a recent survey conducted by the National Headache Foundation (NHF). Survey results reveal that more than 50% of respondents said they frequently or always experience symptoms such as nausea, neck pain, or sensitivity to lights, sounds or smells when suffering from a migraine. Additionally, 78% of respondents said their healthcare professional does not regularly inquire about associated symptoms experienced beyond actual migraine head pain.

“It is extremely important for headache sufferers to talk with their healthcare professionals about symptoms occurring in conjunction with pain,” said Dr. Roger Cady, Vice President and Board member of NHF. “Diagnosis of migraine is based in part on associated symptoms or characteristics such as nausea, vomiting or sensitivity to lights but communication about the entire migraine experience aids your medical provider with proper diagnosis, understanding you, and your specific treatment needs.”

Of those respondents experiencing nausea or vomiting along with their migraine head pain, many reported having to delay taking migraine medication or taking additional medication to manage their nausea. Others said they alternate an injectable form of migraine medication instead of swallowing a pill.

In order to manage migraine head pain and associated symptoms, the majority of survey respondents said they try to maintain a regular sleep schedule, eat balanced meals and reduce stress.

Additional NHF survey results:

  • 78% of survey respondents reported missing work due to migraine pain and/or its associated symptoms.
  • 84% said they frequently or always experience throbbing pain on one-side of their head with their migraine.
  • When asked to rate their migraine pain on a scale of 1-10 with 10 being unbearable, 56% of respondents said their migraine pain is typically between a 7 and 8.

NHF’s tips for dealing with migraine head pain and associated symptoms:

  • Get help. Discuss the associated symptoms of your migraine with your healthcare provider. S/he can help you determine your treatment options.
  • If you experience nausea or vomiting as associated symptoms of your migraine, talk with your healthcare provider about other forms of your medication such as injections, nasal sprays or tablets that do not require drinking water to take them.
  • Avoid identifiable migraine triggers and practice a healthy lifestyle.
  • Track your migraines. Write down when your migraines occur. Bring your results to your healthcare professional to review. A free downloadable headache diary is available at www.headaches.org.