Migraine is a condition that affects millions worldwide, yet the relationship with hormonal changes, particularly during menopause, remains under-discussed. Dr. Katy Munro, a GP headache specialist at the National Migraine Centre and author of Managing Your Migraine, recently shared her expertise in an Instagram Live session. Here, we summarize the valuable insights she provided on migraine, menopause, and effective strategies for management.
What Are Migraine Attacks, and Why Do They Occur?
Migraine attacks are more than just severe headaches. Migraine is a genetic condition influenced by various triggers and changes in the body. According to Dr. Munro, a migraine attack can include symptoms like visual disturbances, nausea, brain fog, and cognitive difficulties. Headache is just one aspect of this multifaceted condition.
Understanding Migraine Triggers
Triggers for migraine attacks are highly individual and can include environmental factors, dietary habits, and even weather changes. Stress, dehydration, and sudden changes in daily routines are common culprits. Hormonal fluctuations during puberty, pregnancy, and menopause often exacerbate migraine, making these life stages particularly challenging for those prone to these episodes.
The Role of Hormones
Migraine attacks can occur at any age but are particularly linked to hormonal fluctuations. Puberty, menstrual cycles, and menopause are critical periods where changes in estrogen levels can either trigger or exacerbate migraine.
During perimenopause, the ovaries’ estrogen production declines irregularly, leading to hormonal fluctuations that can provoke migraine worsening. A sudden drop in estrogen levels is particularly problematic for those with a history of migraine.
Stress, Lifestyle, and Environmental Factors
Stress often accompanies midlife, with responsibilities like caregiving, work pressures, and household management. While stress doesn’t directly cause migraine, it’s a significant contributory factor.. Changes in daily routines, such as skipping meals, poor sleep, or altering weekend habits, can also increase the likelihood of an attack. Additionally, factors like bright lights, strong smells, and loud noises can aggravate symptoms, particularly for those already in the midst of an attack.
Recognizing the Phases of a Migraine
Dr. Munro outlined the phases of a migraine attack:
- Prodromal Phase (Premonition): This phase can start up to two days before the headache. Symptoms include neck pain, fatigue, yawning, or bursts of energy. Recognizing these early signs can help sufferers prepare and mitigate the severity of the attack.
- Aura: About 25-30% of migraine sufferers experience aura, which can manifest as visual disturbances like zigzags, blind spots, coloured sparkles or blurred vision. Aura usually precedes the headache phase and may include other neurological symptoms like tingling or numbness. It lasts up to an hour.
- Headache Phase: This is the most recognized stage, characterized by pain, nausea, and heightened sensitivity to light and sound. The headache phase can last anywhere from a few hours to several days, severely impacting daily activities.
- Postdrome (Recovery): After the headache subsides, many experience fatigue, confusion, or a “hangover” feeling. This phase can leave individuals feeling drained and needing additional rest to recover fully.
Tracking Migraine Patterns
Keeping a migraine diary can be invaluable for identifying triggers and understanding patterns. Note down symptoms, possible triggers, and the effectiveness of treatments during each attack. Over time, this can guide more personalized management strategies.
Differentiating Migraine from Other Headaches
Migraine is often misdiagnosed as tension headaches or stress-induced pain. Dr. Munro clarified the distinctions:
- Tension Headaches are featureless, mild, and don’t typically include symptoms like nausea or light sensitivity.
- Migraine attacks, on the other hand, disrupt daily life and include a spectrum of symptoms.
Migraine can also overlap with other conditions such as sinus headaches or cluster headaches. Proper diagnosis often requires detailed medical history and, in some cases, imaging or other diagnostic tests.
Managing Migraine: Practical Advice
Consistency Is Key
Dr. Munro emphasized the importance of routine in managing migraine. Sleep schedules, meal timings, and stress management practices should be consistent to reduce the frequency and severity of attacks.
SEEDS Strategy:
The SEEDS acronym highlights essential lifestyle factors:
- Sleep: Regular, restorative sleep. Avoiding irregular sleep patterns, including staying up late or oversleeping, is crucial.
- Eating: Balanced meals with healthy fats, proteins, and complex carbohydrates. Avoiding skipping meals and eating at consistent times is essential.
- Exercise: Regular, moderate physical activity. Yoga, walking, or low-impact exercises can be particularly beneficial.
- Diary: Tracking symptoms to identify triggers and monitor patterns over time.
- Stress Management: Techniques like yoga, gratitude journaling, or relaxation exercises can help mitigate stress, a common trigger.
Supplements for Migraine Prevention
Dr. Munro recommends certain supplements to support overall health and potentially reduce migraine impact:
- Vitamin D: Essential for bone health and may reduce episodic migraine. Vitamin K2 may enhance its effects.
- Magnesium: Helps with sleep, anxiety, and perimenopausal symptoms. Magnesium glycinate or bisglycinate are highly bioavailable options.
- Omega-3 Fatty Acids: Found in oily fish or taken as supplements. These may reduce inflammation associated with migraine.
- Vitamin B2 (Riboflavin): Requires a daily dose of 400mg for at least three months.
- Coenzyme Q10: Though costly, it has shown potential benefits for migraine sufferers.
Hormone Replacement Therapy (HRT) and Migraines
During perimenopause, HRT can be an effective tool for managing migraine. By providing consistent estrogen levels, HRT reduces hormonal fluctuations that trigger attacks. Dr. Munro recommends starting with low doses of transdermal estrogen (gel, patch, or spray) and gradually increasing as needed.
Customizing HRT for Migraine Management
For those with migraine, choosing the right HRT method is essential. Patches, which are changed twice a week, may offer steadier estrogen levels than daily gels or sprays. A gradual approach to adjusting dosage can help minimize side effects and optimize benefits.
While HRT isn’t licensed specifically for migraine prevention, it can be beneficial for those experiencing menopausal symptoms alongside migraine. Consulting a specialist is crucial to tailor the approach.
Medications and Advanced Treatments
Acute and Preventative Medications:
Many treatments are borrowed from other conditions, such as:
- Propranolol and Candesartan (blood pressure medications)
- Amitriptyline (an antidepressant)
For those who don’t respond to these, newer treatments like CGRP inhibitors (injections or tablets) are available, though access through the NHS may require meeting specific criteria.
Neuromodulation Devices:
These devices offer non-invasive ways to manage migraine by targeting pain pathways. Examples include transcutaneous electrical nerve stimulation (TENS) units and vagus nerve stimulators.
Holistic Approaches and Emerging Research
Dr. Munro highlighted various complementary therapies:
- Acupuncture: Weekly sessions over eight weeks have shown benefits for many.
- Osteopathy: Particularly helpful for posture or hypermobility-related migraine attacks. Addressing structural issues can reduce muscle tension and improve overall balance.
- Nutrition: A Mediterranean or low-GI diet is preferable over extreme measures like ketogenic diets, which are challenging to sustain. Avoiding processed foods and focusing on whole, nutrient-dense meals is essential.
Research continues to explore new medications and the relationship between migraine, histamine intolerance, and neurodiversity. These studies offer hope for more targeted and effective treatments in the future.
Migraine in Teenagers
Teenagers experience migraine worsening due to hormonal changes, growth spurts, and irregular sleep patterns. Parents should encourage regular routines and open communication to manage symptoms effectively. Adjusting dietary and sleep habits can help stabilize their triggers.
Supporting Teenagers with Migraine
Teenagers often face unique challenges, such as balancing schoolwork, extracurricular activities, and social lives. Encouraging a consistent sleep schedule and educating them about potential triggers can empower them to manage their condition better. Providing access to medical advice and support is equally crucial.
Mental Health and Migraine
Migraine significantly impacts mental health, increasing the risk of anxiety and depression. The unpredictability of attacks often leads to social withdrawal and anticipatory anxiety. Addressing these challenges with a holistic plan that includes therapy, lifestyle changes, and support networks is crucial.
Breaking the Cycle of Anxiety and Pain
The link between migraine and mental health can create a vicious cycle. Mindfulness techniques, cognitive behavioral therapy (CBT), and stress-reduction strategies can help break this cycle and improve overall well-being.
Seeking Help and Support
Dr. Munro emphasized that migraine is not something to “just put up with.” Effective treatments and resources are available. The National Migraine Centre offers consultations without requiring a GP referral. Educational resources, including the Heads Up podcast and Dr. Munro’s book, (Managing Your Migraine, Penguin Life Expert Series), provide invaluable guidance. On Instagram Dr Katy Munro’s brilliant feed can be found under @migrainedoc.
Empowering Migraine Sufferers
Knowledge is a powerful tool. By staying informed about the latest treatments and self-care strategies, migraine sufferers can take control of their condition and improve their quality of life.
Conclusion: Hope for Migraine Sufferers
Migraine can be debilitating, but understanding triggers, implementing lifestyle changes, and seeking appropriate medical or holistic treatments can significantly improve quality of life and reduce the impact of these debilitating attacks. With advancing research and accessible resources, there’s hope for those navigating migraine during menopause and beyond.
