When your period brings a major headache

Q: Whenever I get my period, I get a horrible migraine headache. How can I prevent this?

A: First, know that you are not alone. A quarter of all women suffer from migraines, and almost three-quarters of these have migraines linked to their menstrual cycle.

Like labor pains, migraines are unmistakable. First you feel downright sensitive, and then you “see lights” or feel tingling or numbness. (This “aura” occurs in 20 percent of those with migraines.) Next comes an intense, throbbing pain, usually on one side of your head. There may be nausea or even vomiting. Light and movement make the pain worse. All you want to do is sequester yourself in a dark, quiet room.

It’s unclear why some people are prone to migraines. But it does seem that menstrual migraines are related to fluctuating estrogen levels.

Just before your period, estrogen levels drop. This affects the brain’s neurotransmitters and the sensitivity of the receptors that pick up their messages. Blood vessels dilate, nerves are sensitized and muscles go into spasm.

An over-the-counter solution?
Over-the-counter medications, taken well before it seems you need them, can help prevent menstrual migraines. Take two tablets of naproxen (such as Aleve) twice a day, or two tablets of ibuprofen two or three times a day.

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Start these five to seven days before you expect your period. These medications inhibit the production of prostaglandins, which are substances released during your period that cause cramps and promote that awful headache.

The Pill can help
Birth-control pills, when used appropriately, not only diminish prostaglandin secretion (and therefore the associated cramps), but can also prevent menstrual migraines. Since estrogen decline sets off the headache, if you prevent the decline, you prevent the headache.

To do this, you must take low-dose “monophasic” pills. These contain the same amount of hormones in each pill, as opposed to the differing levels found in “multiphasic” or “triphasic” pills.

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You can use the monophasic pill to create an “extended cycle” by taking it for several months at a time and omitting the “placebo” pills included in the usual birth-control regimen. This will prevent you from undergoing an estrogen decline and from getting your period. (This also holds true for another noncycling pill called Seasonale.)

After a few months, when you do take the placebo pills and get your period, the migraine will likely recur. At this point, I usually prescribe an estrogen patch, the kind used in hormone therapy. This patch should be applied two or three days before the onset of your period so that your estrogen level doesn’t plummet. The patch (in doses of 0.50 to 0.75 mgs) provides enough estrogen to prevent a migraine but not enough to prevent a period.

At one time, the use of estrogen or birth-control pills was not recommended for migraine sufferers because it was thought they could increase their risk for stroke. But the International Headache Society now believes that the Pill is safe for women who have migraines, provided they have no risk factors for coronary or vascular disease. They do suggest, however, that it not be used if the migraine is preceded by significant pre-migraine aura (which may include partial paralysis or speech problems).

Plain old painkillers
If these approaches do not work — or you are unable to follow them for some reason — you will have to resort to painkillers or specific migraine medications.

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Many women use medications that combine acetaminophen (Tylenol) or aspirin with caffeine. These do help, but they sometimes lead to “rebound” headaches, especially if you take the medicine for several days.

Then there are prescription drugs called triptans (Imitrex is a leading brand), which are specially formulated to work on migraines. They are taken as a pill, injection or nasal spray at the onset of the migraine.

In addition, migraines can sometimes be diminished or prevented with long-term use of medications such as tricyclic or SSRI antidepressants, anti-epilepsy drugs or beta blockers.

Dr. Reichman’s Bottom Line: Your periods don’t have to be such a pain above the neck. With the right therapy; you can avoid the torture of a menstrual migraine.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

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