Migraines in women's lives

The term menstrual migraine can be found in many texts on the topic of headaches. It seems so obvious that for many years hardly anyone questioned it. However, research has shown that this taken-for-granted connection between hormones, menstruation, pregnancy, menopause, birth control pills and migraines needs to be put into perspective.

Menstruation and migraines

If you want to define the temporal connection between menstruation and migraines, it makes sense to set the period to the period itself, as well as three days before and after. If you apply this criterion, the statistics show that a maximum of one in twenty women suffering from migraines belongs to this group. In other words: The term menstrual migraine only applies to a small proportion of affected patients.

We know from clinical and experimental studies that the triggering factor is a drop in estrogen levels. The absolute hormone level - whether it is high or low - does not seem to play a role, only the sudden drop.

Further analyzes of hormone concentrations have not yet produced a consistent picture: Neither the levels of follicle-stimulating hormone (FSH) nor luteinizing hormone (LH) differ in patients with menstrually-related migraines from those in healthy control groups.

Treatment of menstrual migraines

Due to the temporal connection with menstruation, it made sense to use hormonal therapy methods. But it turned out that neither hormone patches nor estrogen in tablet form could prevent the attacks. The use of estrogen in the form of a gel that can be applied to the skin does not lead to reliable treatment results. What was explained for the treatment of migraines in the previous chapters generally applies to the treatment of menstrual migraines.

Pregnancy and migraines

Migraines are of particular importance for a possible or existing pregnancy. On the one hand, the question arises as to how migraines should be treated during pregnancy, in particular which medications are indicated or contraindicated. On the other hand, affected patients worry whether their pregnancy is threatened by migraine disease. Finally, it is important to consider what effects pregnancy can have on the course of the migraine attack.

Pregnancy relieves migraines

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Pregnancy is a carefree and pain-free time for most women. It is known from studies that almost 70 percent of affected patients experience a significant improvement or even a complete absence of migraines during pregnancy. This effect is particularly evident in the last two thirds of pregnancy. It is still unclear whether the positive effect on migraines gradually decreases with repeated pregnancies. After delivery, almost half of the patients complain of a recurrence of headaches in the first week, mainly tension-type headaches, but also migraines.

The cause of the sometimes spectacular improvement in migraines during pregnancy is still completely open. However, various hypotheses are discussed. First of all, it is believed that the increased concentrations of estrogen and progesterone and their constant levels during pregnancy are the basis for the improvement.

Other explanations assume that a changed serotonin metabolism during pregnancy and an increased concentration of endogenous opioids (endorphins) are responsible for the improvement. However, the changed lifestyle during pregnancy seems to be of crucial importance: Pregnant women generally eat more consciously, have a regular sleep-wake cycle, avoid alcohol and nicotine, try to live a less stressful life and are less stressed in the work process.

Treatment during pregnancy

In general, drug therapy should be avoided during pregnancy - if at all possible. Of course, this particularly applies to prophylactic measures where medication must be taken daily. These medications (beta-receptor blockers, flunarizine and the serotonin antagonists) must generally not be taken during pregnancy. This is particularly important if pregnancy is planned or even possible. Since young women in particular use such medications for severe migraines, the doctor must inform them of the need for effective contraception. To prevent migraine attacks, we recommend - as usual - primarily behavioral measures such as relaxation exercises and avoiding the triggering factors.

Drug prophylaxis?

If you have extremely severe migraines during pregnancy - especially migraines with aura - you should try magnesium as a preventive measure. The effect of magnesium on the course of migraines was generally rather small in clinical studies, but in individual cases it was extremely impressive.

To treat arterial high blood pressure during pregnancy, the doctor generally prescribes propranolol - a drug that is also used successfully to prevent migraines. There were no teratogenic effects. However, propranolol should only be used very cautiously during pregnancy to prevent migraines and should only be considered as a last resort.

The acute therapy

There is very little literature on the effectiveness and tolerability of medications in the treatment of migraine attacks during pregnancy, with regard to childbirth and breastfeeding. Paracetamol was previously considered the safest painkiller during pregnancy. Based on previous data, safety appeared to be beyond doubt. Pregnant women were recommended to take this painkiller almost without hesitation if they had pain during pregnancy.

However, based on current studies, a careful rethinking of this recommendation is necessary. The use of paracetamol by a pregnant woman and exposure of the unborn child to the drug appear to lead to a significantly increased risk of developing asthma and respiratory diseases in children and possible infertility in boys. In recent years there has been a significant increase in the frequency of asthma globally. Paracetamol is the most commonly used painkiller in Germany. It is number 1 among the most commonly used medicines. At the same time, the frequency of asthma in the population has increased significantly in recent years. Paracetamol can lead to a reduction in glutathione in the lungs. Glutathione is believed to play an important role in the development of asthma.

Of particular concern is the justified suspicion of a significantly increased risk of developing the positional anomaly of the testicle in boys (cryptorchidism). For those affected, this can later lead to reduced fertility and an increased risk of developing malignant testicular tumors. Sperm count and sperm vitality in later life can be reduced. The combined use of two painkillers in pregnant women was associated with a sevenfold increase in the rate of cryptorchidism in newborn boys. It is suspected that the effects of one 500 mg tablet of paracetamol could be more harmful to the unborn child than the ten most common environmental pollutants. Paracetamol was previously considered a safe, harmless, tolerable and inexpensive painkiller in therapeutic doses. The risk that an overdose of more than 150 mg per kg of body weight can trigger irreversible liver cell damage and even liver failure has already led to a limitation in the pack size in the context of self-medication.

The new studies justified a significant rethinking of its use in possible, planned or existing pregnancy. In general, you should avoid taking painkillers during pregnancy and breastfeeding. In individual cases, if the pain is particularly severe, acute medication can be considered after medical advice. However, it must be taken into account that so-called simple painkillers such as paracetamol only have a partial and short effect on the severe attack of pain, but at the same time can cause lasting lifelong risks of complications for the unborn child. The studies were criticized because a causal connection had not yet been definitively proven. However, until the exact connection is clarified, the principle must apply: In case of doubt, for the unborn life and against taking paracetamol, especially in combination with other painkillers. Based on the new data, short-term benefits and long-term lifelong risks are not balanced in the case of possible or existing pregnancy. Contrary to previous recommendations, it is therefore not recommended to take paracetamol in mono- and especially combination preparations if you are pregnant or are already pregnant.

Under no circumstances should ergotamines such as ergotamine tartrate and dihydroergotamine be taken. The substances cause the uterus to spasm during pregnancy. Ergotamine has also been shown to damage embryos.

There are currently no sufficient data regarding the use of triptans during pregnancy. There are reports of pregnancies that have occurred during therapy with sumatriptan, but no problems have occurred. However, until sufficient experience is available, triptans must not be used during pregnancy or breastfeeding.

Details about drug attack therapy and drug prevention can be found in the Pregnancy submenu.

Birth control pill as a trigger?

When migraine attacks are persistent and difficult to treat, birth control pills are often blamed. However, if you look at the facts more closely, there is no clear connection shown in “watertight” (double-blind and placebo-controlled) studies.

The new occurrence of migraine attacks in connection with taking birth control pills is also discussed again and again. Since migraines occur particularly frequently in the second decade of life - exactly the time when birth control pills are usually taken for the first time - there is at least a statistical connection. However, it is currently unclear whether this is a causal connection.

New studies have found that the risk of stroke is increased by a factor of 2 to 3 with migraines. Since the contraceptive pill further increases this risk - especially in connection with smoking - if neurological disorders suddenly occur (e.g. dizziness, paralysis, speech disorders, etc.), a neurological examination should be carried out as soon as possible. This also applies if unexpected headache attacks occur, which can occur on a daily basis.

Menopause and migraines

It is often the opinion that migraines gradually “burn out” as we get older, i.e. their frequency and intensity decreases. However, studies show that more than 50 percent of those affected do not notice any change in the previous course of migraines during menopause and afterwards. Around 47 percent of patients even experience a deterioration.

Even today, some patients with severe migraine attacks are expected to have a hysterectomy or ovary removal to prevent migraines. However, this has been proven to have no influence on the course of a migraine. Even hormone therapies in older age cannot influence migraines. Accordingly, in this situation, migraine therapy should be carried out as usual.