Understanding the Link of Estrogen Levels and Migraine

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Treating migraine in women may pose additional challenges since it is often also affected by hormonal factors. At first boys may be more affected by migraine than girls, however girls soon catch up and tend to develop more migraine cases at puberty. This is the earliest evidence that hormones are related to the progression of migraine. When women are pregnant, their migraines are quite likely to resolve or at least improve, usually after the third month. For women who take oral contraceptive pills, headaches regularly worsen. Women are quite likely to get migraine problems in their early forties, and this may improve after menopause. It means estrogen could be a factor in migraine problems. The likely way estrogen causes migraine is to set off an attack when the estrogen level falls. This is known as estrogen withdrawal syndrome and happens a few days before the menstruation, although it is actually caused by the withdrawal of progesterone instead of estrogen.

Menstrual migraine may stay longer compared to typical migraine attacks and drugs used in treating it is similar to common migraine drugs, although there are a number of additional tricks. Before the period, some women feel better if they get non-steroidal antiinflammatory drugs for a couple of days. If you’re on a prophylactic treatment that works reasonably well but loses its effectiveness when you have a menstruation, gradually raising the dose a few days before the actual menstruation begins could help. Sometimes, estrogen patches can be used to blunt the effects the estrogen withdrawal. Magnesium may help and diuretics have been commonly used. They eliminate the bloating you have during the period, but don’t do very much to eliminate the headache. Prophylactic triptans, for example frovatriptan, naratriptan and sumatriptan seem to be effective in making menstrual migraines better.

To rid themselves of debilitating headaches, many women agree to have hysterectomy. This is often a mistake. First, it’s not the menstrual period that causes the migraine. The ovaries produce estrogen, so removing uterus makes no sense. The real problem is that if your ovaries are creating their own estrogen, although if you take estrogen drugs, there could still be fluctuating estrogen levels that trigger migraine attacks. If you are desperate and think that estrogen is the culprit, a chemically-induced menopause is possible, and it is reversible when the medication is discontinued. With proper drugs, like long-acting estrogen preparations, estrogen level is controllable. However, frequently migraine problems can be handled by more conventional techniques.

You can’t predict what would happen to your migraine problem when taking estrogen replacement therapy, but normally something will happen, however. Premarin is the most common type of estrogen replacement therapy, which is a concoction of multiple kinds of estrogen. It seems that estrogen patches, which gradually release estrogen will prevent precipitous falls and make the symptoms less severe. Other estrogen preparations could also be acceptable; especially those which include male sex hormones. Check for implantable forms, which may give continuous, very even estrogen levels. But what if you’re pregnant? What could happen to your migraine problems, and what it takes to relieve them? Luckily, migraines will improve during pregnancy, especially after the third month.

Unfortunately, we don’t know a good deal about the drug safety for pregnant women, so it is a good idea to employ non-medication methods whenever possible. Some drugs can be bad for pregnant migraine patients. Ergots may cause uterus contraction and miscarriages. Depakote (divalproex sodium) can cause severe deformities. Simple painkillers with acetaminophen and butalbital (Phrenilin, Fiorinal, Esgic, Fioricet) might be safe when used occasionally, but it is worthwhile to be aware about our lack of understanding on drug safety for pregnant women. Occasionally, the risks of migraine problems with its accompanying dehydratic, vomiting, and nausea could be significant during pregnancy. Medication, for example with Imitrex shots, could be advantageous. In pregnancy, we definitely don’t test the situation deliberately by giving potentially dangerous medicines to pregnant women. Our only understanding comes from prospective or retrospective observations of those who took them. However according to scientific method, this way of analyzing risk is somewhat flawed. Therefore, it could be difficult to fully assess drug safety for pregnant women.

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Christopher Jacoby

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