Maya has had the best life, fulfilling all her roles as a thriving professional, a loving wife and a doting mother with skill and grace. She has always been well-respected and admired by all for her boundless energy and zest for life.
But now, in her 40s, her life seems to have changed very quickly, with the onset of migraines. The episodes were occasional at first, and she would think stress or lack of sleep was to blame. But, with time, they have become more frequent and more intense, breaking her confidence and making her feel incapable. Maya, who was once a force to reckon with, now finds herself struggling even to get through the day.
Can you relate to this story? Have you experienced something similar? Before you feel disheartened, know that Maya hasn’t given up. She has decided to reset her lifestyle and manage her migraines rather than fight them. She is also enlisted in support groups, which provide much-needed comfort and encouragement. You can follow in Maya's footsteps too. And we at Miyara, are here to support and empower you.
Hormonal fluctuations can trigger migraines in perimenopause
Perimenopause, the transitional phase leading up to menopause, is marked by hormonal fluctuations that can significantly impact physical, mental, emotional and social health (relationships and adaptability). One of the common and often debilitating symptoms experienced during this time is an increase in migraine frequency and severity. Migraines are different from regular headaches.
Menstrual migraine affects about 20–25% of female migraineurs in the general population, and 22–70% of patients presenting to headache clinics. Additionally, in women diagnosed with menstrual migraine, perimenstrual migraine attacks are associated with substantially greater disability than their non-menstrual attacks.
Another study of 237 women aged 30-34 showed that more than 1 of every 5 female migraineurs have migraine in ≥50% of menstruations.
According to the Headache Classification Committee of the International Headache Society, migraine is a common neurovascular syndrome, which is typified by intense, unilateral, throbbing and pulsatile headache attacks, lasting for 4–72 hr and accompanied by anorexia, nausea, vomiting, photophobia and/or phonophobia. In about 15% of patients, an aura (visual disturbance) may precede the migraine headache within about 1 h (classical migraine; migraine with aura).
While the exact cause remains unclear, there is strong evidence suggesting that both the timing and frequency of migraine attacks are influenced by hormone-related events. The most widely proposed “estrogen withdrawal hypothesis” suggests that the fall in estrogen levels is responsible for this. Other female sex hormones have shown involvement in studies too, but their mechanisms of action are obscure. Taken together, female sex hormones are thought to influence/ trigger migraines through a complex interplay of central and peripheral neurological pathways.
Risk Factors
Pre-existing migraines - during menstruation or otherwise
Family history - particularly female relatives
Sleep disturbances - both in quality and quantity of sleep
Stress - physical, mental or emotional
Medical interventions - hormonal therapy can increase risk for some women
Type of menopause - interestingly, migraines seem to reduce in a substantial faction of women after spontaneous menopause but can worsen after surgical menopause due to abrupt hormonal decline.
While there is no cure, several strategies can help improve the quality of life during this time.
Management Strategies - Therapeutic Interventions
OTC or prescription medication: This includes non-steroidal anti-inflammatory drugs (NSAIDs), dietary supplements like Mg, riboflavin and Co-Q10, triptans as well as antidepressants, anticonvulsants, or beta-blockers in cases of severe headaches.
Hormone Replacement Therapy (HRT): HRT may be helpful but it has pros and cons in migraine management. Talk to your doctor about its potential risks and benefits.
Behavioral therapy is an umbrella term for practices to relax the mind and body consciously. It includes mental and muscle relaxation techniques. In some cases, Biofeedback therapy is advised. This involves learning to control physiological responses like heart rate, muscle tension, and skin temperature, which can help manage stress and reduce migraine frequency. It should only be done under the supervision of skilled professionals.
Neuromodulation devices: Prescription-based devices (headband or armband electrodes) and implantables have shown promising effects in migraine management. These work by delivering electrical currents to stimulate or modulate nervous system responses. However, these devices are still in their early stages of development.
Management Strategies - Lifestyle Changes
Regular, restful sleep: This is undoubtedly the most helpful intervention for managing migraines. Aim for 7-8 hours of uninterrupted sleep each night to regulate your body's internal clock and reduce stress.
Combating stress: Relaxation techniques, meditation, deep breathing or progressive muscle relaxation can also prevent migraine triggers.
Regular exercise: Moderate-intensity physical activity most days of the week can improve overall health and reduce stress. It is ok to listen to your body and skip exercise during a menses or migraine episode if you don’t feel up to it.
Prioritising vitamins and minerals: Anti-inflammatory foods like ginger and turmeric, green leafy vegetables, nuts and seeds, whole grains and legumes rich in vitamins and minerals (especially folate, riboflavin and magnesium) can help.
Hydrating well: Drink enough fluids to prevent dehydration, which can initiate headaches.
Limiting known triggers: Identify and avoid potential migraine triggers, such as certain foods, drinks, strong odors, loud noises or bright lights.
Management Strategies - Alternative Therapies
Ice or heat therapy: Applying a cold compress to the forehead or back of the neck can help alleviate pain. Alternatively, a warm compress can relax tense muscles.
Essential oil application: Topical administration or inhalation of lavender and peppermint oils are often used for headaches.
Traditional medicinal practices: Herbal packs and techniques that target pressure points have been indicated for pain management. These should only be done by a skilled professional.
Massage Therapy: Regular massage can help reduce tension and muscle pain, while improving blood circulation.
Green Light Therapy: The principle behind this therapy is that all light generates electrical signals in the retina, with red and blue lights generating the largest signals and green light generating the smallest signals which are better tolerated even by people with photophobia. Migraineurs are exposed to a specific, narrow band of green light emitted from a special lamp as initial research suggests it can improve migraine symptoms and pain. A study from 2022 also showed a significant decrease in headache days in episodic and chronic migraine sufferers.
Take care
Remember, early diagnosis and appropriate treatment can help improve the quality of life for women experiencing this challenging phase of life. Talk to your healthcare provider for personalised treatment approach if your condition is particularly debilitating or difficult to manage.
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About the author
Kanchana is a Lifestyle Consultant & Weight Management Specialist. After a Masters degree in Molecular Biology from the USA, she ventured into the field of Nutrition and is certified in General Nutrition, Sports Nutrition, and Weight Management. Her own successful weight loss journey inspired her to help people of all age groups and health conditions via Calorie Culture, which she founded in 2012. She is also an avid dancer, mini marathoner, and sports enthusiast. She strongly advocates sustainable lifestyle changes as a means to long-term health benefits and optimal weight.
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