Menstrual Migraine Headaches
Frederick R. Jelovsek MD
Migraine headaches are more common in women and 60-70% of women with migraines report some relationship with their menstrual period. Usually there is an increased frequency before, during and after menses. There is a category of migraine that is called a true menstrual migraine. This is a migraine headache that occurs regularly, each month but only between the 2nd day before the menses and the end of menstruation. Menstrual migraine is thought to occur in about 14% of women.
Sometimes, what is a migraine headache versus what is just a chronic tension-type headache gets confused. A recent publication, Ling FW et al (eds.): Strategies for the management of headache. Association of Professors of Gynecology and Obstetrics Educational Series on Women's Health Issues. 1998, had a good discussion of the different types of headaches in women. They organized the International Headache Society classification of headaches:
Headache Diagnostic Criteria
| Migraine without aura | Migraine with aura | Chronic tension-type |
|---|---|---|
| At least 5 attacks fulfilling the following criteria: | At least 2 attacks having at least 3 of the following characteristics: | -- |
| headache lasts 4-72 hours if untreated | one or more aura symptoms occur and are fully reversible | average frequency of 15 days per month for 6 months |
| headache includes at least two of the following characterisitcs -- unilateral location, pulsating quality, moderate to severe intensity which inhibits or prohibits daily activity, aggravation by routine physical activity | at least one aura symptom develops gradually over more than 4 minutes or 2 or more symptoms occur in succession. | at least 2 of the following pain characteristics: pressing or tightening, mild or moderate severity, bilateral location, not aggravated by physicial activity |
| headache is accompanied by at least one of the following -- nausea and/or vomitting, light or sound sensitivity | no single aura symptom lasts more than 60 minutes | no vomiting |
| -- | headache begins just before or within 60 minutes of an aura | nausea, light or sound sensitivity |
| Plus | ||
| other disease/disorder process is ruled out or if present, migraine attacks do not occur for the first time in close temporal relation to the disease/disorder | secondary cause excluded by a medical evaluation | -- |
Almost one in six women are thought to suffer from migraine headaches with a peak incidence between ages 25 and 55. Of those women only about 40% have been diagnosed by a physician.
Aura symptoms
- visual flashing lights, bright zig-zag patterns or blind spots
- loss of balance
- change or loss in level of consciousness
- double vision
- ringing in ears or hearing loss
- dizziness
- difficulty moving
- bilateral weakness or nerve feeling disturbance
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