Migraine: A perimenopause curse?  

Migraine is one of the most common and disabling neurological disorders, whose economic and social effects are significant given its impact on people’s quality of life, work, social activities and family life.

Did you know that there are different types of migraines?

• Migraine with or without the aura (aura being a status of sensory alterations like changes in hearing, speech, touch and vision).
• Migraine without headache, only presenting other symptoms like vision problems or aura.

Migraine is chronic when it occurs at least 15 days per month for minimum 3 months – ouch!

Who is most impacted?

The global prevalence of migraine is approx. 15%, with chronic migraine affecting approx. 2% of the world population.

Stats show that migraine affects women disproportionally, with 85% of chronic migraine sufferers being women.

Interestingly this prevalence only seems to emerge after puberty, prior to puberty the impact on boys and girls is the same.

It also appears that women experiencing premenstrual syndrome (PMS) have an increased prevalence of migraine during perimenopausal years.

The good news is that if a woman had not experienced migraine during earlier years, the onset of migraine is quite rare during perimenopause, while unfortunately attacks can often worsen in women who did experience them earlier in life, in particular for women with menstrual migraine.

According to a recent Lancet review paper, menstrual migraine effect between 20-25% of female migraineurs worldwide.

So, are our beautiful hormones to blame?

While the pathophysiology of migraine is quite complex and not fully understood (definitely not something for this blog post), we know that there are few factors playing a role in the triggering of a migraine attack.

And yes, hormones can definitely be blamed in some cases.

But watch out – it is not just their absolute levels that can create problems, but also their relative level and their fluctuation during the month and our lifetime. And as we know perimenopause, akin to puberty, is a time of hormone fluctuations.

Studies have shown that:

• Oestrogen withdrawal at the end of the cycle is possibly a trigger for menstrual migraine attacks (often happening without aura)
• High levels of oestrogen (i.e., leading to ovulation), which yes do happen during perimenopause, can also be a trigger for migraine (often with aura), linked to the role that oestrogen plays in the release of prostaglandins and histamine.

A small pilot study has also highlighted as trigger low level of allopregnanolone. Allopregnanolone is a metabolite of progesterone that modulate expression of GABA (our happy hormone and neurotransmitter) and ultimately exert a role against inflammatory stimuli.

No, hormones are not the only ones to blame though!

There is much more at play. And the stats above should not scare you, but just make you aware that you are not alone.

Very often migraine attacks are a combination of factors and lack of sleep, skipping meals, stress, certain foods, medications can also be culprits for the onset of a migraine attack.

Every person is different, and every migraine can be different and driven by a different trigger.

If you struggle with migraine, what could you do?

Keep a diary: Understanding what triggers your migraine is key. There is no way to really address the problem if the drivers are not clear. Any pill will have a temporary palliative effect on the problem, will not eradicate it.

• Maybe it is some foods you eat? It doesn’t need to be the obvious culprits like gluten, chocolate, MSG etc. You could be sensitive to other foods too…
• Maybe it is the same period of the month? Is it before ovulation, at the end of the period?
• Maybe it is when you repeat certain actions long enough – like driving for too long, sitting still for too long? Might have something to do with your posture?

Keep yourself fit, both physically and mentally: I don’t think we can ever imagine living stress free, but we can modulate our reaction to it. Exercise regularly. Give yourself time to experience deep breathing and/or some meditation.

• If you are thinking you have no time. Well think about the time you’ll lose in bed or in a dark room when you do get the next migraine attack :-/ – prevention is key!

Keep yourself hydrated: Too obvious right? Well not always. Aim for at least 2L of water everyday. Infuse the water with some fresh herbs (organic or home grown if you can) or roots like ginger and turmeric. They contain powerful compounds to help against inflammation.

Check your gut: How is your gut doing? Do you have at least a bowel movement a day? That is key to excrete toxic compounds… Migraine is often associated with gastrointestinal disorders like IBS, Constipation, Coeliac disease.

Manage your stress: At the end of the day, it is your life and you should dictate the way you want to live it (within boundaries I guess, if you have kids this might not apply – LOL!). Acute stress is great, we all need a bit of that. Chronic stress is not instead and actually that is reported as a trigger for migraine by ~80% of sufferers (my hand is up here!). Define your priorities being aware of the fact you are your own priority!

Having struggled with migraine most of my adult life, it is with great pleasure that I covered this topic hoping it can help, as much as knowledge and lifestyle interventions helped me moving from 1-2 migraines a month to 1-2 a year.

In the next blog I will share my personal story with migraines taking you through the steps I followed to get to the bottom of it and what I do when I get them.