Treating migraines in women

Hormonal fluctuations can trigger migraines in women; for example, many women experience regular headaches that appear to be related to the drop in their estrogen levels immediately before the start of the menstrual flow. Birth control pills, and hormone replacement therapy during menopause, also can affect the frequency or severity of headaches. Some women get their first migraines while pregnant; in others, migraines go away during pregnancy.

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The medications of choice in the treatment of menstrual migraine are nonsteroidal anti-inflammatory medications (NSAIDs). The NSAIDS most often used for menstrual migraine include:

• ketoprofen (Orudis)
• ibuprofen (Advil and Motrin)
• fenoprofen calcium (Nalfon)
• naproxen (Naprosyn)
• nabumetone (Relafen)

Therapy with the NSAID should be started two to three days before the onset of the menstrual flow and continued throughout. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.

Other medications prescribed include:

• small doses of ergotamine (including Bellergal-S) or a similar compound, methylergonovine maleate (for example, Methergine)
• beta blocker drugs such as propranolol
• anticonvulsants such as valproate
• calcium channel blockers such as verapamil

These drugs should also be started two to three days premenses and continued throughout the menstrual flow.

Because fluid retention is often associated with one's period, diuretics have been used to prevent menstrual migraine. Some physicians may recommend that the patient follow a salt-restricted diet immediately before the start of menses.

The medication Lupron affects hormone levels and is used only when all other treatment methods have been tried and been unsuccessful.

Migraines may also be associated with hormone replacement therapy taken during menopause. For patients who need to continue post-menopausal estrogen supplements, the patient should be started on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, the patient should take it on a daily basis. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may be effective in stabilizing the levels of estrogen.

During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy. A mild analgesic, such as acetaminophen, can be used for pain. It is imperative that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists.