Migraine, a common and debilitating neurological disease, affects one in seven people worldwide.
In Mumbai alone, roughly 1.5 to 2 million people experience migraine headaches. It forms one of the top 10 leading causes of years lived with disability and poses significant disease burden.
Having said that, women are three times more likely to be affected by migraine than men.
They are typically affected by migraine between 15 and 49 years of age.
Besides, of women migraineurs, 60 percent experience menstrual-related migraines.
Menstrual migraines are caused by fluctuations in estrogen and progesterone levels especially during menstruation.
These attacks can happen anywhere from 2 days before the start of menstruation, during or up to 3 days after menstruation ends.
Typically, menstrual migraine onset may occur at the time of an individual’s first period and attacks may continue throughout the reproductive years, sometimes during menopause too.
Research suggests that menstrual migraines tend to be more intense or severe, last longer and have more significant symptoms of nausea as compared to migraines not associated with an individual’s menstrual cycle.
Although severity may differ, typical menstrual migraine symptoms remain similar to those of other migraines – vomiting or nausea and sensitivity to bright lights and sounds.
These can further limit abilities to pursue daily activities.
This condition is also highly under-reported. Further, it is under-diagnosed, often because most of the women end up considering their symptoms as a normal part of their menstrual cycle.
They may also confuse it with premenstrual syndrome (PMS) symptoms – such as bloating, nausea, tenderness or pain, and mood changes, some of which accompany menstrual migraine attacks.
Thus, they typically avoid consulting a general practitioner or specialist, suffering in silence. In the absence of medical help, they may feel distressed, misunderstood or even helpless.
Migraine’s adverse consequences, especially if untreated, are far-reaching, affecting individuals’ personal, social and professional lives during their prime productive years.
Menstrual migraine can exacerbate their typical migraine symptoms, which can result in difficulties in everyday functioning and concentration and declining work performance and productivity.
Difficulties at work can also be attributed to a lack of understanding amongst colleagues and employers about the individual’s condition, or not taking it seriously due to the misconception of migraine being ‘just a headache.’
Enhanced understanding of the condition forms a critical component of migraine management – as workplace policies or routines established with one’s employer can afford migraineurs greater agility and flexibility, in terms of working hours as well as leaves of absence.
Migraine & Menstrual Migraine: Monitoring Symptoms
In order to understand whether one’s symptoms are attributed to migraine, or menstrual migraine particularly, reaching out to a neurologist is important.
To alleviate the pain, prevent attacks and better manage menstrual migraine, a few key steps can be undertaken. One is tracking or monitoring – of both migraines and periods.
Migraine tracking, which can be done with the help of a migraine diary, for instance, can include noting down the day and time, intensity, symptoms and progression through stages, if any.
Regular monitoring can enable patients and neurologists to identify patterns and triggers, which can inform treatment decisions and lifestyle modifications to prevent attacks, while also offering insights regarding the effectiveness of treatment solutions adopted.
Simultaneously, tracking one’s menstrual cycle can be a helpful determinant of menstrual migraine patterns, and especially important with regards to knowing when to expect an attack so preventive measures can be accordingly adopted.
Less than 25 percent of migraine patients are able to deal with their condition effectively.
Treatment Options
In the case of menstrual migraine, which is reportedly refractory or more resistant to treatment, establishing a holistic, comprehensive migraine management plan is essential.
Treatment for such migraines can differ depending on menstrual cycle factors – including the severity of pain of periods or cramps, the patient’s contraception solutions, and severity of attacks during periods.
Consulting a neurologist to understand the preventive care that can be undertaken, in the case of typical or hormonal-related menstrual migraines, is a vital step to get ahead of the condition.
Timely treatment coupled with lifestyle and dietary modifications can also facilitate smoother migraine management at home.
Avoiding personal migraine triggers (like bright lights, foods with strong odours, cured meats, caffeine and alcohol, chocolate, etc.), while establishing a healthy sleep routine, flexible working schedule, and managing stress can be helpful at-home solutions to adopt.
With through timely diagnosis, customised treatment and adherence, menstrual migraine can be effectively managed to reduce the disruption to an individual’s daily life.
(The author, Dr Rahul Chakor is the Head of Neurology at Nair Hospital, Mumbai.)
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