Our panel of experts answer your questions about how migraine can affect women throughout their lives.
Women will go through many changes throughout their lives that can impact migraine. There are challenges with menstrual migraine, safe pain treatment during pregnancy and menopause impact on migraine. We talked to a panel of experts who tackled your most pressing questions. Dr. Christine Lay, Dr. Addie Peretz and Valerie Lawler, NP, participated in our “Migraine and Women’s Health: Your Questions Answered” webinar. This article compiles the most popular topics and questions posed to the panel. We hope this serves as a guide and resource for you.
Q: Why do women experience more migraine?
A: Men experience migraine, but it’s more common in women. Migraine normally starts at the same age as menarche—a woman’s first period—but it can also start at any age. It continues throughout a woman’s lifetime and is most common during the childbearing years. Women also experience longer-lasting, more frequent and more disabling migraine attacks.
Q: I get my worst migraine just before my period. Is this common?
A: Dr. Peretz says you are in “good company” if your migraine gets worse around your period. “There are a lot of women who suffer from migraine around menstruation. There’s even a term for this: it’s called menstrually related migraine,” says Dr. Peretz. “Menstrual migraine starts two days before menstruation and can last for three days into a woman’s period.”
“Until recent studies, this was often cast aside, that perhaps women weren’t coping as well,” says Dr. Lay. “Studies showed in the recent decade that it definitely is much more burdensome, harder to treat, harder to get rid of attacks. So, women were right all along.”
Q: What type of nonmedicine treatments can help?
A: Nurse Lawler says lifestyle factors can play a huge role in managing migraine and that they serve as an important foundation in women’s health. “We can’t build a really strong migraine management plan without that effective foundation,” says Nurse Lawler. The following are a few lifestyle factors that Nurse Lawler says are the most important when it comes to managing migraine:
- Eat three meals a day made up of a healthy, balanced diet
- Don’t skip breakfast
- Eat only healthy snacks in between meals
- Avoid additives such as artificial colors, flavors and sweeteners
- Drink plenty of plain water to keep the brain hydrated
- Don’t oversleep or undersleep
- Aim to keep sleep schedule the same every night
- Build in a stress management routine through relaxation exercises or mindfulness-based meditation
- Be proactive and don’t wait for stressors and crises
- Vitamin D, riboflavin (vitamin B2) and magnesium citrate
- Nurse Lawler says it’s best to talk with your healthcare provider to learn which vitamins might be best for your unique situation
Q: I would like to take the pill—can I?
A: Changes in a woman’s hormones can play a role in migraine. Dr. Peretz says for women living with migraine without aura, there are birth control methods that can help to minimize the drop in estrogen (a group of hormones responsible for women’s reproductive health) during a period and help with migraine management. However, this is not always the case.
“Not all hormonal contraceptives will make things better. Sometimes migraine gets worse,” says Dr. Peretz. “It’s important to kind of follow your pattern and see what’s happening.”
Women with migraine with aura are at an increased risk for stroke. Birth controls containing estrogen can further increase that risk. For this reason, women with aura should talk with their doctor about birth controls containing estrogen. Dr. Peretz says it’s also best to talk to your doctor to learn which form of birth control is the safest and most effective for you.
Q: I want to get pregnant, but I’m worried about my migraine. What are the risks?
A: Many people with migraine need medication to function and get better. It’s common for women with migraine to have concerns about becoming pregnant and how it will affect their current medication treatment plan and health.
“Everyone understands that when you’re pregnant, the number one thing you want to do is avoid medication,” says Dr. Lay. “The good news is for the vast, vast majority of women, particularly women who have menstrually related migraine without aura, they do very well in pregnancy.”
Dr. Lay says almost 80% of pregnant women with migraine see improvement in their symptoms by the second trimester of pregnancy. She says there could be a few weeks that pregnant women with migraine need to scale back on their commitments at work and home.
“For women who have migraine with aura, that is less likely to improve. And, for some women, they may actually experience their first migraine attack with aura during pregnancy,” says Dr. Lay. “Overall, we tell our patients that there is good news, and we can really work with individuals to help them be prepared for pregnancy so their migraine does improve.”
Q: If I am pregnant, what can I take?
A: Dr. Lay suggests that patients should first stop using medications that are contraindicated—medications that can cause harm during pregnancy. She says it’s also important to separate these medications so they are not accidentally taken during a migraine attack. Dr. Lay says to avoid mixing over-the-counter acetaminophen with caffeine to allow babies’ organs to grow and develop properly.
“There is some data to suggest that for severe attacks certain triptans may be safer than others,” says Dr. Lay. “We don’t recommend that you take triptans purposefully throughout pregnancy, but there is a little bit of pregnancy registry data, particularly for the earlier developed triptans—sumatriptan, rizatriptan—that may be safer during pregnancy.”
Nerve blocks can also work because they are deemed to be safe during pregnancy. Nerve blocks can be helpful in getting pregnancy migraine under control earlier.
“As always, we recommend you talk to your obstetrician-gynecologist about what you’re taking,” says Dr. Lay. “If you have a headache neurologist, certainly include them in the conversation about things that you do want to consider trying.”
Q: What can I take when I am breastfeeding?
A: It’s very common for migraine to begin again shortly after delivery. If you are planning to breastfeed, the good news is breastfeeding can protect against the return of migraine. It’s best to talk with your doctor before breastfeeding to ensure that any medications you are taking do not interfere with your breast milk.
When it comes to medications to take while breastfeeding, Dr. Lay says to go back to the basics with lifestyle management, device therapy, occipital nerve blocks and over-the-counter medications. “If it becomes to the point where a woman really does need something like the triptan, a triptan that she took prior to pregnancy might not be the right triptan to take during breastfeeding because of the mechanics of how it gets into the breast milk.”
Some women will take their medication and pump and discard milk so they get rid of the peak dose of medication. Dr. Lay says this option will require a backup supply of milk or supplementing with formula.
Q: I’m in perimenopause and my migraine is so terrible—should I get a hysterectomy?
A: Nurse Lawler says it’s a common question. Many women reach the point where they wonder if having a hysterectomy would help them to get rid of their hot flashes and perimenopausal symptoms. Nurse Lawler’s response?
“No. That is not a treatment for migraine,” she says. “It’s not going to make your migraine better. In fact, it can make your migraine worse.”
Though migraine commonly gets better after a woman has her final period, Nurse Lawler says that the transitional period after a woman’s last period can take years. “Sometimes women have to be patient. We have to continue to work with adjusting treatment, reinforcing lifestyle and effective other perimenopausal symptoms that come along with it,” says Nurse Lawler.
Q: Will my migraine go away with menopause?
A: The symptoms of menopause can continue for two years, in some cases even longer, after a woman’s final period. After menopause, women generally experience some improvement in their migraine but it’s not always guaranteed.
Hormonal changes are not the only thing that can trigger migraine. Poor sleep, weather changes and family history can all play a role in migraine that persists after menopause.
Dr. Lay says it’s important to keep a headache diary to track and monitor migraine attacks. A simple, uncomplicated diary can help a patient and doctor determine if there is a relationship between ovulation and migraine.
Q: I’m having bad hot flashes. Can I take hormonal therapy? Can a woman with migraine with aura be on hormone replacement therapy?
A: Hormone replacement therapy (HRT) is not recommended for treating migraine by itself. However, many studies show that women with menstrually related migraine are more vulnerable to vasomotor symptoms—symptoms that occur due to the constriction or dilation of blood vessels. These symptoms can include:
- Hot flashes or heat-rising sensations
- Sleep disruption
- Night sweats
- Changes in mood
- Lower energy
- Drop in sex drive
“If HRT is recommended for those reasons, then generally we feel if a woman has migraine without aura, it’s reasonable to have a short course of HRT,” says Dr. Lay. “Some women do better with patch therapy because it provides a more steady state. Other women do better with bioidentical (hormones that are identical to the ones your body produces).” It’s best to talk with your provider to determine which therapy, if any, is best for you.
Dr. Lay says women who have experienced “very simple visual aura” that lasts five to 10 minutes for their entire lives could consider a brief course of HRT. But if there is any change in aura pattern, HRT should be stopped immediately.
“The good news is that many of the preventative medicines that we use to treat migraine are also beneficial in terms of managing the symptoms of perimenopause and menopause,” she says. “You get a two for one: an improvement in your migraine and an improvement in your perimenopausal symptoms.”
Migraine can seem tricky to navigate, especially for women who go through many changes in their lifetimes. If you’re a woman with migraine, it’s important to remember that many women go through this and that you are not alone. Talking with your doctor and including them in all the different stages of your life is the most effective way to find a treatment plan that is best for you.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.