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Understanding PMS Migraines
by Dr. Daniel J. Heller
Migraine headaches can be downright incapacitating on their own; when they are part of the spectrum of premenstrual syndrome symptoms, the combination can be truly debilitating. In fact, migraines may make PMS symptoms worse. Ordinarily, PMS symptoms are bad enough: bloating, moodiness, and cramping can really take a toll, especially when they occur month after month. Add headaches or migraines to the mix, though, and it can be hard to function.
There are two kinds of migraine headaches that are labeled menstrual migraines. The most common is menstrually-related migraine: this PMS migraine can occur during the few days before the period and the first few days of the period itself, as well as during the rest of the month. Pure menstrual migraines, in contrast, occur only during that time period. Menstrual migraines are defined as "migraines without aura," meaning they don't have the typical pre-migraine onset symptoms.
Up to two-thirds of the 20 million women with migraines in the United States find their headaches get worse around the time of the period. For these women, migraine attacks are two or three times more likely at this time of the month. PMS migraines are more severe, and harder to treat, than other types of migraine headache.
Realistically, though, many migraines that occur around the time of the period won't fit neatly into these categories, either because they occur with auras, or they occur earlier or later than this strict definition. Also, since one hallmark of premenstrual syndrome is an aggravation of a chronic migraine condition, it would be hard to argue that a migraine with an aura that occurs eight days before the period, in the presence of other PMS symptoms, is not a menstrual migraine.
Not all headaches that occur around the time of the period are migraines, however. Tension headaches and a variety of other types of headache can occur before, during, or after the period. As with PMS, any symptom that regularly recurs in a cycle with your hormones is likely caused by some type of imbalance in your body's hormone regulation.
Although several theories have been proposed to explain menstrual migraines, there is clearly a relationship to the changing hormones of the reproductive cycle, and most specifically to the drop in estrogen levels that occurs in the second half of the cycle. However, all women experience some degree of decline in estrogen levels during this luteal phase, but not all get menstrual migraines. And it is not as if women with migraines have a clear deficiency of estrogen or other hormones—blood hormone levels in women with migraines are almost always completely normal.
Therefore, there must be some other susceptibility that causes some women to get migraines. This susceptibility could be genetic, biochemical, hormonal, or nutritional. While we can't know the exact cause of menstrual headaches in every woman, we do know that certain triggers tend to bring on migraines.
Among the more common migraine triggers are:
In addition to the short-term triggers, there are also diet and lifestyle factors that seem to cause, or at least severely aggravate, a predisposition or susceptibility to migraines. Many of these are discussed below.
Unfortunately, most women with menstrual migraine assume it is a normal part of the menstrual cycle, and don't even mention the symptoms to their doctor. So, the first step to overcoming this debilitating problem is to recognize it as a real problem and not just something you have to live with. We've met women who thought their PMS headaches were unavoidable because their mother or aunt or friends also experienced them, when in fact those women may well have needed to address some of the imbalances we discuss below.
Most people with migraines seem to feel that they are often brought on by stress, and a stress response certainly could make migraines worse, or act as a trigger in those predisposed to them. In fact, relaxation training appears to be one of the helpful ways of dealing with chronic migraines. Cognitive behavioral therapy has also been shown to be effective, suggesting that finding better ways to deal with stress can help improve migraines.
When stress combines with fluctuating hormones, not to mention the stressful PMS symptoms that may be occurring at the same time, it can be a hard cycle to break. Nevertheless, finding a way to handle stressful events and episodes so that they don't tax your health and add to your suffering is well worth the effort.
While we often think of a spa retreat or a day with few responsibilities as the best escape from stress, it's important to remember that stressful events can happen anytime, and we can always try to manage how we react to those events. So while a massage can help, the best stress response could lie in remembering to take a deep breath and ask ourselves if, in this situation, it's actually worth "sweating the small stuff." Of course, if migraines are part of PMS, it can make it nearly impossible to control one's reactions to events—in which case the events don't seem like "small stuff" at all! That's why the best approach is to try to deal with, and prevent, the cause of PMS symptoms.
An ongoing pattern of powerful reactions to ordinary events—powerful enough to throw us out of balance and bring on painful and distressing symptoms—can be a sign that things are somehow out of balance in our lives. At times like this, counsel from a professional or from clergy can help us find a better perspective on our lives, allowing more ease and comfort, and less stress.
Not that we would argue with a spa treatment or a massage! Other stress-busting things you can do to regain control of your emotions and stress levels: keep caffeine levels to a minimum; eat breakfast daily; keep sweets and baked goods as an occasional treat rather than a regular part of your diet; get at least seven (and preferably eight) hours of sleep per night. And don't forget regular (moderate) exercise, which is one of nature's best ways to discharge stress.