Diagnosis, Treatment and Prevention of Hormonal Headaches

How do you Diagnose Hormonal Headaches?

There is no diagnostic test for hormonal headaches and diagnosis is usually based on patient history. To facilitate the diagnosis, it is helpful to maintain a diary for a minimum of three menstrual cycles to help check if the headaches occur at a particular point in the menstrual cycle.

How can you Treat Hormonal Headaches?

The treatment of hormonal headaches depends on the age of the patient and the severity of the headaches.

Medications for Relief of Acute Attacks

Some medications are beneficial in providing acute pain relief and are taken once a headache or migraine attack has started. These includethe following:

• NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, celecoxib, indomethacin, and naproxen can be taken for moderate headaches. Combinations of NSAIDs and analgesics like paracetamol are also effective
• Triptans: For severe headaches, triptans, which are a class of tryptamine-based, migraine-specific drugs, may be required for reducing the severity of the headaches. Triptans relieve the headache within two hours and also control associated nausea and vomiting
• NSAID + Triptan Combos: Sometimes a combination of NSAIDs and triptans may be given. Another drug that may be advised is dihydroergotamine (DHE), which is an ergot alkaloid. However, this cannot be taken with triptans

Medication for Migraine Prevention or Prophylaxis

For women who get recurrent and disabling hormonal headaches, medications to prevent these headaches (migraine prophylaxis) may be advised. These medications may have to be taken daily or just before the time in the menstrual cycle when these occur. These medications include the following:

• Beta Blockers: These drugs are primarily used for treating high blood pressure, but are also effective for migraine. They block the action of the hormone epinephrine e.g. propranolol, atenolol, bisoprolol
• Anticonvulsants: These drugs prevent convulsions or epileptic seizures e.g. acetazolamide, carbamazepine, clonazepam
• Antidepressants: These are used for depressive disorders, but are also effective against migraine e.g. amitriptyline, imipramine, doxepin
• Calcium Channel Blockers: These drugs block movement of calcium ions through calcium channels. They lower high blood pressure and are useful for migraine also e.g. amlodipine, diltiazem, nicardipine, verapamil
• Magnesium: Since there is a fall in magnesium levels in the brain during a migraine attack, magnesium oxide supplementation may be helpful in preventing migraine
• Calcitonin Gene-related Peptide (CGRP): This is neuropeptide produced by the brain and produces severe migraine. Some monoclonal antibodies are antagonists of CGRP, thereby preventing migraine

Continuous Contraceptive Pills

These are a new type of contraceptive pill that are also known as combination pills since they contain both estrogen and progestin. They shorten the monthly periods, reduce their frequency or even eliminate them altogether, thereby reducing the chances of migraine. Advice may be sought from a doctor about taking these combination pills, if the headaches get worse during the last week when the conventional pills become hormone free.

Hormone Replacement Therapy

For perimenopausal women, hormone replacement therapy (HRT) is usually given to treat hot flushes and sweats. However, for migraines, your doctor may recommend a gel or estrogen patch as it delivers a constant dose of estrogen and prevents or reduces the frequency of hormonal headaches.

Biofeedback

Biofeedback is a technique that trains you to relax certain muscles to reduce headache frequency and changing the way you respond to stress or certain situations. It can be beneficial for some women with hormonal headaches.

How to Prevent Hormonal Headaches?

Though hormone fluctuations are a natural phenomenon and occur in all women, you can try these simple measures to reduce the frequency and severity of hormonal headaches:

• Avoid skipping meals. Take small frequent meals. Never skip breakfast
• Try to reduce stressful activities or develop coping measures such as relaxation and deep breathing exercises, meditation and yoga
• Develop a regular sleep pattern and don't miss out on adequate sleep
• Exercise regularly
• If you are taking the oral pill, consult your doctor for dose or treatment modifications
• Take migraine prophylaxis if you develop these headaches regularly

References:

1. Menstrual migraine - (https://www.migrainetrust.org/about-migraine/types-of-migraine/menstrual-migraine/)
2. Headaches & Migraines - (https://womeninbalance.org/symptoms-solutions/headaches-migraines/)

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