Menstrual migraine

Our Global Medical Institute center focuses on the localization of pain during a migraine attack, and identifies three main categories of migraine: frontal migraines, occipital migraines and temporal migraines. Several forms and locations of migraine may exist simultaneously on one or both sides.

Global Medical Institute makes a point of distinguishing between the different forms of migraine, depending on where your migraine pain starts. Three main points are identified: in the back of the neck, in the temples or under the eyes.

As you can see, it is very important for you to be able to pinpoint the pain, the starting point of your pain, so that we can offer you the right treatment. A treatment that will soothe you, calm your pain and reduce or even eliminate the symptoms of your migraine.

In these few lines, we will give you some details about menstrual migraine so that you can find out more.

Why is it important to locate the starting point of your pain? What is a menstrual migraine? What treatments are available at Global Medical Institute?

This section will help you make a free and informed choice.

The importance of localizing menstrual migraine pain

As mentioned above, it's very important for all our patients to be able to locate the starting point of their pain.

Indeed, if you can locate the starting point (or starting points) of your pain expression, our surgeons will be able to help you treat your migraine, whether temporal, occipital or frontal.

At our Global Medical Institute center, we focus first and foremost on the starting point of the pain, before proposing any medical or surgical treatment.

Sometimes, an initial consultation can be carried out via teleconsultation from the comfort of your own home: Global Medical Institute's specialists will be able to explain whether your suffering can be relieved by our minimally invasive approach.

By focusing on the location of the pain, we give ourselves the means to treat your symptoms. That's why it's important for you to be able to locate it.

It is important to get a precise definition of your migraine, but all our patients tend to get lost in the different types of migraines, denominations, definitions and so on.

Migraine cannot be defined by several names, and there are many different types of migraine. Our neurologists specialize in the classification and treatment of migraines. Our surgeons specialize in treating the pain expression of your migraines.

The only important point to focus on is the location of the pain, in particular the point of pain onset. It's from this location that we'll be able to help and relieve you, whether the pain is frontal, occipital or temporal.

If the starting point of the pain is consistent with trapped nerves or vessels, if that is where you started to feel pain: that's where our doctors and surgeons can act. We decompress the nerve and free it from the structures that are trapping it: these structures can be vessels, muscles, tendons, etc.

What is a menstrual migraine?

A menstrual or “catamenial” migraine is one in which the pain is felt between two days before and three days after the first day of menstruation.

As with “ophthalmic migraine”, “menstrual” migraine is in fact a typical migraine that takes the form of so-called aura-free attacks, i.e., not accompanied by other neurological signs. However, “menstrual” migraines are more severe and last longer than those occurring at other times of the female hormonal cycle. It also responds less well to treatment.

The International Headache Society recognizes two types of catamenial migraine:

• pure catamenial migraine, with no attacks outside the menstrual period,

• migraine aggravated by menstruation, combining aura-free attacks triggered during menstruation with other attacks, with or without aura, which can occur at any time.

What causes a menstrual migraine?

As mentioned above, menstrual migraine is associated with a typical migraine whose pain is triggered by the menstrual cycle.

So, if it Is a migraine aggravated by menstruation, the causes of this migraine are linked, as with all migraines, to the influence of genetic and environmental factors.

These may include stress and emotions, too little or too much sleep, dietary or climatic factors, exposure to noise or flashing lights...

In the case of pure menstrual migraine, hormonal fluctuations have an impact on the onset of migraine and the course of the disease.

In women suffering from catamenial migraine, the sharp drop in endogenous oestradiol levels, which usually reach their minimum on the 1^st day of menstruation, but sometimes up to 5 days before, is a powerful triggering factor. Attacks are said to be hormone-dependent. The role of progesterone, another female hormone reaching its lowest level at the start of menstruation, remains debated.

As you will have gathered, the symptoms of menstrual migraine are no different from those of a classic migraine without aura: pain mainly on one side of the head, aggravated by physical activity, which may be accompanied by nausea and vomiting, and hypersensitivity to light and noise. Here, the trigger is known, hence the name.

Often recurrent, attacks are generally more prolonged and intense than migraine attacks triggered outside the menstrual cycle.

What treatments does Global Medical Institute offer for your menstrual migraine?

Medical treatment:

In all cases, resting in the dark, away from noise and light, will help prevent the attack from worsening.

Migraine treatment is based on avoiding triggers wherever possible.

Moreover, the earlier patients take their medication, the faster the attack will be relieved. Patients are advised to take 1g of aspirin at the time of the aura, or a non-steroidal anti-inflammatory drug (NSAID) to limit pain.

If this is not enough, we recommend the classic migraine treatment: triptans, which can also be combined with NSAIDs.

If necessary, anxiolytics or antiemetics can be added. Unfortunately, catamenial migraine often proves resistant to these treatments.

Prophylactic treatment:

Designed to reduce the frequency of attacks and alleviate symptoms, this consists of a non-specific preventive treatment based on NSAIDs, administered twice a day in the perimenstrual period, and a specific preventive treatment designed to avoid the sudden drop in estrogen. In practice, this generally involves an estrogen-releasing cream or patch applied two days before the period and lasting seven days.

This treatment is also possible when migraine attacks occur in women on estroprogestogenic contraception during the window of interruption of the pill or its alternatives, vaginal ring or patch. In such cases, it is also possible to choose an oral contraceptive to be taken continuously, or with interruption windows shortened to four or two days. For other women, permanent cessation of estrogen, replaced by a pure progestin contraceptive, eliminates attacks.

If menstrual migraines do not respond to conventional treatments or hormonal approaches, it's possible that your pain is also linked to compression of a nerve or vessel in the forehead, neck or temples. An assessment by your Global Medical Institute expert surgeon can confirm this possibility.

In some cases, an initial consultation can be carried out by teleconsultation from the comfort of your own home: Global Medical Institute's specialists will be able to explain whether your suffering can be relieved by our minimally invasive approach.