What are you doing for your menstrual migraines?
August 15, 2022 2:59 PM Subscribe
How do you cope with debilitating pain several days a month when the usual solutions don't work?
Tried some low dose hormonal bc. Already had been getting migraines now and then but after I used the birth control for a few weeks, I am getting 5-15 migraines a month. Seen in the headache clinic. Have prn prescription and a monthly preventative injection. Need more ideas for self treatment/care. Should I try hormones again to see if it will rebalance them to where they were before or is that not how hormones work? I'm going to ask my Dr that question but my obgyn seems to not really understand how migraine, hormones and stroke risk all fit together so I'm crowd sourcing additional data. YANMD.
I'm not asking for medical advice. I cannot just tap out of all responsibilities for the 3-5 days each month I'm getting these severe migraines. Nurtec helped the ones not associated with my period but seems to not touch these. The doctor was like the only other option is to give you something to make you sleep so you can sleep through it. I have to parent and work. I can take off work sometimes but I can't just call out whenever I get a migraine. I can't take Maxalt because it increases stroke risk. So what do I do?
Magnesium, caffeine are not helping.
I live in an area with high humidity, bright sun, very swingy weather and can't move just to stop my migraines.
I wear tinted FL-41 glasses (dupes) to reduce the risk.
Do I just get my uterus removed? Does that stop menstrual migraines? I'm willing to consider it if so.
Tried some low dose hormonal bc. Already had been getting migraines now and then but after I used the birth control for a few weeks, I am getting 5-15 migraines a month. Seen in the headache clinic. Have prn prescription and a monthly preventative injection. Need more ideas for self treatment/care. Should I try hormones again to see if it will rebalance them to where they were before or is that not how hormones work? I'm going to ask my Dr that question but my obgyn seems to not really understand how migraine, hormones and stroke risk all fit together so I'm crowd sourcing additional data. YANMD.
I'm not asking for medical advice. I cannot just tap out of all responsibilities for the 3-5 days each month I'm getting these severe migraines. Nurtec helped the ones not associated with my period but seems to not touch these. The doctor was like the only other option is to give you something to make you sleep so you can sleep through it. I have to parent and work. I can take off work sometimes but I can't just call out whenever I get a migraine. I can't take Maxalt because it increases stroke risk. So what do I do?
Magnesium, caffeine are not helping.
I live in an area with high humidity, bright sun, very swingy weather and can't move just to stop my migraines.
I wear tinted FL-41 glasses (dupes) to reduce the risk.
Do I just get my uterus removed? Does that stop menstrual migraines? I'm willing to consider it if so.
So the answers that solved my pre-menstrual migraines may not solve yours (except the solution where I stopped being a university student who was working two jobs, starting a new relationship, and helping run a successful all-volunteer org and then those migraines subsided).
I suspect that for you, one thing that may help is to find a way to carve out some quality crunchy potato time. Every day.
posted by aniola at 3:35 PM on August 15, 2022 [1 favorite]
I suspect that for you, one thing that may help is to find a way to carve out some quality crunchy potato time. Every day.
posted by aniola at 3:35 PM on August 15, 2022 [1 favorite]
I'm a doctor
I know you're not asking for medical advice, but...
Triptans are a class of medicines designed to treat migraine or cluster headache. They have been extensively evaluated in the context of menstrual migraines (MMs), and found to relieve pain better than placebo during the first 4 hours of MMs. Of the seven unique triptans currently available, Frovatriptan is considered the best of the group
Other than triptans, only one medication--a common analgesic called Mefenamic acid--is associated with pain relief for MMs.
NOTE: to date, no studies of nonsteroidal anti-inflammatory agents have been done. Advil, Motrin, Alleve, Tylenol, Aspirin etc may or may not be helpful. No harm in trying them out
NOTE: Timing strongly effects efficacy. Drugs should be taken as soon as possible following the onset of pain. This is very important.
posted by BadgerDoctor at 3:39 PM on August 15, 2022 [11 favorites]
I know you're not asking for medical advice, but...
Triptans are a class of medicines designed to treat migraine or cluster headache. They have been extensively evaluated in the context of menstrual migraines (MMs), and found to relieve pain better than placebo during the first 4 hours of MMs. Of the seven unique triptans currently available, Frovatriptan is considered the best of the group
Other than triptans, only one medication--a common analgesic called Mefenamic acid--is associated with pain relief for MMs.
NOTE: to date, no studies of nonsteroidal anti-inflammatory agents have been done. Advil, Motrin, Alleve, Tylenol, Aspirin etc may or may not be helpful. No harm in trying them out
NOTE: Timing strongly effects efficacy. Drugs should be taken as soon as possible following the onset of pain. This is very important.
posted by BadgerDoctor at 3:39 PM on August 15, 2022 [11 favorites]
Anecdote 1: Birth control ABSOLUTELY made my migraines worse. In my case, I had taken the pill for decades so didn’t know they were related until I stopped taking them & the migraines almost completely stopped.
Anecdote 2: Hysterectomy solved my mother’s lifetime of migraines, but not all were period-related.
posted by gryphonlover at 3:39 PM on August 15, 2022 [4 favorites]
Anecdote 2: Hysterectomy solved my mother’s lifetime of migraines, but not all were period-related.
posted by gryphonlover at 3:39 PM on August 15, 2022 [4 favorites]
The only thing that worked during the menopause years was a prescription triptan. I couldn’t take natural hormones, artificial ones, nor testosterone or birth control pills. Each of those caused really bad migraines. Keeping a list of my trigger foods and stopping all artificial sweeteners were the only ways to combat the migraines until they ceased after menopause. No shrimp, no wine, no chocolate during those years.
posted by serendipityrules at 4:16 PM on August 15, 2022 [2 favorites]
posted by serendipityrules at 4:16 PM on August 15, 2022 [2 favorites]
Continuous b/c stopped mine. Then I was dx w/ breast cancer that was HR+. I take Lupron to shut down my ovaries which also worked for me. Now that I'm 5.5 years out, I'm getting my ovaries and uterus removed so the menstrual ones won't come back.
I currently have other triggers that I haven't been able to identify so I use a monthly injection (Ajovy) and triptains as needed.
posted by kathrynm at 4:21 PM on August 15, 2022 [2 favorites]
I currently have other triggers that I haven't been able to identify so I use a monthly injection (Ajovy) and triptains as needed.
posted by kathrynm at 4:21 PM on August 15, 2022 [2 favorites]
If you know the timing of an expected migraine ahead of time, maybe you can schedule a migraine-treating massage for that time.
Magnesium is good, but I take a combination electrolyte tablet (from a health food store) when I have heat/light/fatigue migraine, and it seems to help. That may be mainly because I often don't eat enough at those times (nausea), but it's worth trying. I started when it turned out that Cambia had potassium in it, so I figured, why not just find something that has potassium that's non-prescription.
If you haven't tried Cambia -- it's an NSAID, diclofenac potassium, that comes in powder form; you dissolve it in 1/4 c. water and drink that -- I recommend it.
Aerobic exercise might help... it's something to try.
posted by amtho at 4:24 PM on August 15, 2022 [1 favorite]
Magnesium is good, but I take a combination electrolyte tablet (from a health food store) when I have heat/light/fatigue migraine, and it seems to help. That may be mainly because I often don't eat enough at those times (nausea), but it's worth trying. I started when it turned out that Cambia had potassium in it, so I figured, why not just find something that has potassium that's non-prescription.
If you haven't tried Cambia -- it's an NSAID, diclofenac potassium, that comes in powder form; you dissolve it in 1/4 c. water and drink that -- I recommend it.
Aerobic exercise might help... it's something to try.
posted by amtho at 4:24 PM on August 15, 2022 [1 favorite]
I hadn't heard of stroke risk with Maxalt (rizatriptan). I just searched and found a couple of studies that showed that migraneurs were at increased risk of stroke, and they were identified by their use of triptans. I didn't see work showing that triptans, or Maxalt specifically, increased stroke risk.
I'm not saying it's safe, just that I didn't turn up that relationship easily. So, if you're not totally certain, it might be worth investigating further.
On the other hand, if this is a known side effect, please follow up and let me know!
posted by amtho at 4:26 PM on August 15, 2022 [1 favorite]
I'm not saying it's safe, just that I didn't turn up that relationship easily. So, if you're not totally certain, it might be worth investigating further.
On the other hand, if this is a known side effect, please follow up and let me know!
posted by amtho at 4:26 PM on August 15, 2022 [1 favorite]
Response by poster: I should clarify that my doctor told me to stop the Maxalt because I have autoimmune vasculitis and that is what makes it too risky. My headache specialist used to work in a stroke clinic. It was a fluke that I happened to be assigned to him to even be given that information. However, it's possible that his concerns are based on a form of vasculitis I don't have. Mine is more of a problem for my skin than my heart or brain as far as I know. I will have to send a message to clarify.
I'm researching and apparently it's not even clear whether low or high estrogen triggers autoimmune flares. But I am realizing that estrogen supplements are probably out because of that. Maca powder triggers autoimmune fatigue. Flo vitamins which have chasteberry and other clinically proven pms symptom reduction gave me autoimmune fatigue flares too. Sophie's choice between debilitating migraine pain/nausea/sensitivity or debilitating fatigue. Le sigh.
The relationship between estrogen, autoimmune and migraine is clearly one that is clinically significant, but none of my physicians seem very knowledgeable about it, including the rheumatologist that specializes in vasculitis. So I am updating my post to ask: How do I find a doctor to help solve this puzzle if the high caliber specialists in my area don't seem to understand it? I am aware of functional/integrative medicine but (a) they are usually bougie and expensive, and (b) there seems to be a lot of junk science mixed in with probably good science and therefore it's hard to tell the quality of the professional providing the services.
posted by crunchy potato at 4:50 PM on August 15, 2022
I'm researching and apparently it's not even clear whether low or high estrogen triggers autoimmune flares. But I am realizing that estrogen supplements are probably out because of that. Maca powder triggers autoimmune fatigue. Flo vitamins which have chasteberry and other clinically proven pms symptom reduction gave me autoimmune fatigue flares too. Sophie's choice between debilitating migraine pain/nausea/sensitivity or debilitating fatigue. Le sigh.
The relationship between estrogen, autoimmune and migraine is clearly one that is clinically significant, but none of my physicians seem very knowledgeable about it, including the rheumatologist that specializes in vasculitis. So I am updating my post to ask: How do I find a doctor to help solve this puzzle if the high caliber specialists in my area don't seem to understand it? I am aware of functional/integrative medicine but (a) they are usually bougie and expensive, and (b) there seems to be a lot of junk science mixed in with probably good science and therefore it's hard to tell the quality of the professional providing the services.
posted by crunchy potato at 4:50 PM on August 15, 2022
Hah, I was going to write try a rheumatologist but you have. Honestly when you have a weird multi-system condition, you have to self-manage and bring up things with the doctors pretty assertively.
It is super common to try several types of meds before finding what works. I adjusted life stuff to be calmer and more migraine-friendly, and no longer take a preventative because of side effects, relying instead on codeine painkillers at a low dose. My kid takes a preventive because the side-effects are lower than the pain-killers for her.
It is also common to have to change headache doctors. I lucked out with my first, but was transferred to my second who I strongly dislike and have to actively manage - I'm in a public system and can't easily switch.
Nurtec did not work for me much at all. I take 16mg of codeine at the start of a migraine which mutes it enough to carry on, up to 3-4x a day. I try to space it out because of the paracetamol in the pills, but generally need it about 5-10x a month. Is this an American thing where you can't access reasonable painkillers?
posted by dorothyisunderwood at 5:11 PM on August 15, 2022 [2 favorites]
It is super common to try several types of meds before finding what works. I adjusted life stuff to be calmer and more migraine-friendly, and no longer take a preventative because of side effects, relying instead on codeine painkillers at a low dose. My kid takes a preventive because the side-effects are lower than the pain-killers for her.
It is also common to have to change headache doctors. I lucked out with my first, but was transferred to my second who I strongly dislike and have to actively manage - I'm in a public system and can't easily switch.
Nurtec did not work for me much at all. I take 16mg of codeine at the start of a migraine which mutes it enough to carry on, up to 3-4x a day. I try to space it out because of the paracetamol in the pills, but generally need it about 5-10x a month. Is this an American thing where you can't access reasonable painkillers?
posted by dorothyisunderwood at 5:11 PM on August 15, 2022 [2 favorites]
Response by poster: Re: your last question. Yes. There is an "opiate epidemic" in America so most doctors are not quick to prescribe them.
posted by crunchy potato at 5:17 PM on August 15, 2022
posted by crunchy potato at 5:17 PM on August 15, 2022
My understanding is that it's fluctuations in estrogen levels that induce migraines, rather than high or low estrogen. So the effect of birth control on migraines may depend on whether the pills are monophasic, biphasic, or triphasic or one of ones like Seasonale where you only take placebo pills/bleed a few times a year.
posted by needs more cowbell at 6:16 PM on August 15, 2022 [2 favorites]
posted by needs more cowbell at 6:16 PM on August 15, 2022 [2 favorites]
Can you do a progestin-only pill instead of one with estrogen in it? I did a combined pill and had a migraine 5 days in a row and couldn’t take it anymore. The progestin-only one didn’t give me any migraines (at least not more so than what I normally get, which is one every few months).
posted by loulou718 at 8:54 PM on August 15, 2022
posted by loulou718 at 8:54 PM on August 15, 2022
1) do you have children? I almost entirely stopped getting menstrual migraines when I had a second child. Decreased after one, I’ve had maybe 6 in 9 years since the second was born.
2) fioricet is the only medicine that helped me. It’s a barbiturate, and after I take it I am pretty much gonna sleep for several hours (the dose says once every four hours as needed - I have no idea what the hell I would be like if I tried that!). Used to be that my migraines would last three-four days. Fioricet will cut that to 11-18 hours.
posted by dpx.mfx at 11:46 PM on August 15, 2022
2) fioricet is the only medicine that helped me. It’s a barbiturate, and after I take it I am pretty much gonna sleep for several hours (the dose says once every four hours as needed - I have no idea what the hell I would be like if I tried that!). Used to be that my migraines would last three-four days. Fioricet will cut that to 11-18 hours.
posted by dpx.mfx at 11:46 PM on August 15, 2022
I'm a neurologist and migraneur. (As are many of us. That Venn diagram is almost a circle.)
I came in to mention Frova as well, but reading your update about vasculitis, I'd err on the side of caution re triptans until you can get confirmation that your particular vasculitis doesn't affect brain vessels. All triptans are going to be vasoconstrictive though.
I hate Fioricet bc I've seen too many people get addicted and wind up with medication overuse headaches. Excedrin (acetaminophen/aspirin/caffeine) doesn't have a barbiturate but still prone to MOH.
There are lots of other preventatives out there. CGRP inhibitors and gepants (Nurtec et al.) are sexy right now, but sometimes the old school meds work better. There's a lot of trial and error with migraine care, unfortunately.
On the selfcare side, I know my triggers well, some of which are in my control and many of which aren't. Sleep is the hardest to get under control for me (3.48am,why am i awake?) I love red wine but mostly opt for white these days, unless I've had a solid couple nights' rest. For whatever reason most other migranous foods are ok (for now).
Good luck. Migraines are the worst.
posted by basalganglia at 1:02 AM on August 16, 2022 [4 favorites]
I came in to mention Frova as well, but reading your update about vasculitis, I'd err on the side of caution re triptans until you can get confirmation that your particular vasculitis doesn't affect brain vessels. All triptans are going to be vasoconstrictive though.
I hate Fioricet bc I've seen too many people get addicted and wind up with medication overuse headaches. Excedrin (acetaminophen/aspirin/caffeine) doesn't have a barbiturate but still prone to MOH.
There are lots of other preventatives out there. CGRP inhibitors and gepants (Nurtec et al.) are sexy right now, but sometimes the old school meds work better. There's a lot of trial and error with migraine care, unfortunately.
On the selfcare side, I know my triggers well, some of which are in my control and many of which aren't. Sleep is the hardest to get under control for me (3.48am,why am i awake?) I love red wine but mostly opt for white these days, unless I've had a solid couple nights' rest. For whatever reason most other migranous foods are ok (for now).
Good luck. Migraines are the worst.
posted by basalganglia at 1:02 AM on August 16, 2022 [4 favorites]
I completely empathize with this -- migraine sufferer for at least the last 12 years that I was on bc. Even lo-loestrin triggered a crushing headache for 48 hours. The only thing that stopped the migraine cycle was getting off the pill and switching to another method. Sucked but it worked for me. In menopause now, haven't had a migraine since 2018. I hope you find relief.
posted by missmobtown at 7:36 AM on August 16, 2022 [1 favorite]
posted by missmobtown at 7:36 AM on August 16, 2022 [1 favorite]
I got terrible migraines while on birth control (low-dose estrogen), but they went from blinding pain with nausea to "merely" bad headache that only triptans could touch after I cut out all artificial sweeteners. Alas, it took me several more years to realize that the pill was what was causing most of the headaches in the first place.
The other thing I discovered that was triggering my migraines was muscle strain in my neck and upper back from attempting to strength train without assistance on proper form. They'd trigger tension headaches which would, in turn, trigger migraines. Menopause meant that I only got the tension headaches, which at their worst were indistinguishable from migraines except that OTC meds would lessen them. That was eventually fixed with sessions with a private trainer.
posted by telophase at 7:59 AM on August 16, 2022 [1 favorite]
The other thing I discovered that was triggering my migraines was muscle strain in my neck and upper back from attempting to strength train without assistance on proper form. They'd trigger tension headaches which would, in turn, trigger migraines. Menopause meant that I only got the tension headaches, which at their worst were indistinguishable from migraines except that OTC meds would lessen them. That was eventually fixed with sessions with a private trainer.
posted by telophase at 7:59 AM on August 16, 2022 [1 favorite]
Response by poster: Thanks everyone. A couple follow up comments then I am done replying.
I took progesterone only pills after giving birth and that small dose of hormones triggered pretty significant depression so I had to stop taking it.
The bc that triggered these menstrual migraines was Yaz which is considered "ultra low dose." But, I have ADHD and there was a day I skipped accidentally, which triggered a 3-day migraine and 15 days of bleeding. If missing one dose causes such problems, then solving the problem with daily medication seems counterintuitive to me.
I am trying to figure out triggers. Menses, possibly chocolate, extreme weather changes, barometric pressure changes (including fluctuations that are lower than what the "migraine buddy" app considers significant), and bright sunshine are all factors. The Nurtec helps with most of the other triggers if I take it early. But nothing has helped these menstrual ones. I'm sure limiting sugar and artificial sweeteners would probably help but I developed disordered eating when I attempted keto so I hesitate to try to do that.
I am desperate enough that I contacted my spouse's ex wife who trained in functional medicine for a referral and found someone that can allegedly address the interplay between these different areas. We will see if that helps and in the meantime I appreciate the other ideas.
posted by crunchy potato at 8:15 AM on August 16, 2022
I took progesterone only pills after giving birth and that small dose of hormones triggered pretty significant depression so I had to stop taking it.
The bc that triggered these menstrual migraines was Yaz which is considered "ultra low dose." But, I have ADHD and there was a day I skipped accidentally, which triggered a 3-day migraine and 15 days of bleeding. If missing one dose causes such problems, then solving the problem with daily medication seems counterintuitive to me.
I am trying to figure out triggers. Menses, possibly chocolate, extreme weather changes, barometric pressure changes (including fluctuations that are lower than what the "migraine buddy" app considers significant), and bright sunshine are all factors. The Nurtec helps with most of the other triggers if I take it early. But nothing has helped these menstrual ones. I'm sure limiting sugar and artificial sweeteners would probably help but I developed disordered eating when I attempted keto so I hesitate to try to do that.
I am desperate enough that I contacted my spouse's ex wife who trained in functional medicine for a referral and found someone that can allegedly address the interplay between these different areas. We will see if that helps and in the meantime I appreciate the other ideas.
posted by crunchy potato at 8:15 AM on August 16, 2022
I see that you said magnesium doesn't work, but I wonder which magnesium you're taking. My doctor specifically recommended magnesium glycinate, 400 mg a day. So I take 200 in the morning and 200 in the evening. I went from 4-7 day migraines every month to only one a year since taking it.
Migraines are absolutely awful and I hope you find relief.
posted by poppunkcat at 9:09 AM on August 16, 2022 [1 favorite]
Migraines are absolutely awful and I hope you find relief.
posted by poppunkcat at 9:09 AM on August 16, 2022 [1 favorite]
Your triggers are my triggers.
I started prophylactic Advil about a day before I expected my period.
I always wear sunglasses AND a hat in the sun (i found it seems to be the squinting that was the trigger) I try to keep hydrated. I
take magnesium, Co-Enzyme Q-10, Riboflavin every day. I also am very careful about my caffeine consumption. One can of Coke or cup of coffee per day, in the AM, period.
I make rigorously sure I go to bed and get up at the same time each day.
I take a triptan prn for migraines. And I still was getting so may per month.
I finally decided to try Botox. My neurologist said I was a good candidate. I am so glad I did. My monthly total of of migraines is less than half of what it was before.
I had no side effects at all. Highly recommend.
good luck!
posted by mmf at 10:46 AM on August 16, 2022
I started prophylactic Advil about a day before I expected my period.
I always wear sunglasses AND a hat in the sun (i found it seems to be the squinting that was the trigger) I try to keep hydrated. I
take magnesium, Co-Enzyme Q-10, Riboflavin every day. I also am very careful about my caffeine consumption. One can of Coke or cup of coffee per day, in the AM, period.
I make rigorously sure I go to bed and get up at the same time each day.
I take a triptan prn for migraines. And I still was getting so may per month.
I finally decided to try Botox. My neurologist said I was a good candidate. I am so glad I did. My monthly total of of migraines is less than half of what it was before.
I had no side effects at all. Highly recommend.
good luck!
posted by mmf at 10:46 AM on August 16, 2022
If the artificial sweeteners are a problem with you like they were with me, instead of just cutting them, would switching to a different one, like stevia, work? This is assuming you're using aspartame, which appeared to be the trigger for me (diet sodas). You know yourself better than I do, though!
posted by telophase at 11:34 AM on August 16, 2022
posted by telophase at 11:34 AM on August 16, 2022
I would talk to your neurologist about other preventative medication options. Sounds like you're already on one of the injectables like Emgality. It's honestly a lot of trial and error. There are also things like botox. I have a running notes doc on my phone about which drugs I've tried and what works.
It's also been trial and error for me for which rescue/abortive drugs works too. Some triptans work better for different people than others. I also find that taking a little klonapin (anti-anxiety) helps relax me.
Have you tried any of the devices such as Cephaly or Nerivio Migra? Nerivio was more affordable for me so I tried that and it helps.
The only way I figured out my food triggers was by using a food diary for 3 months and writing down literally every single thing I ate. I like mySymptoms for iPhone.
Another thing that helped my migraines was getting my rhinitis (allergies) under control. When my migraines kicked up again a few months ago, it coincided with an uptick in symptoms (runny nose, sneezing, etc.). My allergist adjusted my allergy meds and my migraines got back under control within a few days.
In terms of non-drug things to help in the moment, I'm sure you've done the "ice pack on the face in a dark room", which is not the most convenient but it helps me. I like to lie down on a heating pad with an ice pack on my forehead, and I do a 20 minute body scan meditation. I get so anxious/tense when I get a migraine so the relaxation really helps.
I already see a PT for a neck injury, and she has noticed that when I get migraines my face/scalp get super tense and are hard to relax. She does great massage/release on my face/scalp - it feels great and really helps with the migraines. Might be worth finding a good PT or massage therapist to help you out.
posted by radioamy at 12:24 PM on August 16, 2022 [1 favorite]
It's also been trial and error for me for which rescue/abortive drugs works too. Some triptans work better for different people than others. I also find that taking a little klonapin (anti-anxiety) helps relax me.
Have you tried any of the devices such as Cephaly or Nerivio Migra? Nerivio was more affordable for me so I tried that and it helps.
The only way I figured out my food triggers was by using a food diary for 3 months and writing down literally every single thing I ate. I like mySymptoms for iPhone.
Another thing that helped my migraines was getting my rhinitis (allergies) under control. When my migraines kicked up again a few months ago, it coincided with an uptick in symptoms (runny nose, sneezing, etc.). My allergist adjusted my allergy meds and my migraines got back under control within a few days.
In terms of non-drug things to help in the moment, I'm sure you've done the "ice pack on the face in a dark room", which is not the most convenient but it helps me. I like to lie down on a heating pad with an ice pack on my forehead, and I do a 20 minute body scan meditation. I get so anxious/tense when I get a migraine so the relaxation really helps.
I already see a PT for a neck injury, and she has noticed that when I get migraines my face/scalp get super tense and are hard to relax. She does great massage/release on my face/scalp - it feels great and really helps with the migraines. Might be worth finding a good PT or massage therapist to help you out.
posted by radioamy at 12:24 PM on August 16, 2022 [1 favorite]
I was unable to tolerate the several contraceptive pills I tried because it set off depression.
I *was* able to tolerate the Mirena IUD just fine for over a decade (definitely had less depression while I was on it? But maybe that was coincidence?). It turns out because it's targeted essentially, it releases about 1/10th the hormones of the lowest dose pills.
Now if I'm reading these two articles correctly -
https://www.womenshealthmag.com/health/a19942467/caution-birth-control-and-migraines-dont-mix/
https://www.migrainedisorders.org/podcast/how-hormones-impact-migraine-1/
(Which I might not be?)
It seems to be saying that Yaz doesn't have much hormones, but the one it does, drospirenone-ethinyl estradiol, increases stroke risk in women with aura migraines, and according to second article might not be helping with the migraines?
Going by the last few paragraphs of the second article, progesterone pills taken continuously with no fluctuation should help migraines, but between the adhd (I have that too, every day pills? Hell no), and them setting off depression, that seems like a no.
The Mirena shouldn't make the migraines worse, is continuous, and should have low enough release of progesterone that hopefully, like me, you shouldn't have the depression side effect.
However it's a bit of an investment if its not covered for you.
So, good luck, and hope this gives you some options to think about, since that second article has a lot of advice.
posted by Elysum at 7:27 PM on August 16, 2022 [1 favorite]
I *was* able to tolerate the Mirena IUD just fine for over a decade (definitely had less depression while I was on it? But maybe that was coincidence?). It turns out because it's targeted essentially, it releases about 1/10th the hormones of the lowest dose pills.
Now if I'm reading these two articles correctly -
https://www.womenshealthmag.com/health/a19942467/caution-birth-control-and-migraines-dont-mix/
https://www.migrainedisorders.org/podcast/how-hormones-impact-migraine-1/
(Which I might not be?)
It seems to be saying that Yaz doesn't have much hormones, but the one it does, drospirenone-ethinyl estradiol, increases stroke risk in women with aura migraines, and according to second article might not be helping with the migraines?
Going by the last few paragraphs of the second article, progesterone pills taken continuously with no fluctuation should help migraines, but between the adhd (I have that too, every day pills? Hell no), and them setting off depression, that seems like a no.
The Mirena shouldn't make the migraines worse, is continuous, and should have low enough release of progesterone that hopefully, like me, you shouldn't have the depression side effect.
However it's a bit of an investment if its not covered for you.
So, good luck, and hope this gives you some options to think about, since that second article has a lot of advice.
posted by Elysum at 7:27 PM on August 16, 2022 [1 favorite]
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Removing your uterus does not stop your hormone cycle or ovulation.
I am now in surgical menopause and my migraines have gotten far less bad. I cannot take estrogen so I only take testosterone for menopause. But there are many, many options for migraines before surgical menopause, which isn't a guarantee. There are also meds that can mimic menopause by suppressing hormones, some are marketed toward endometriosis patients. (NOTE that those usually don't act as birth control and you can't take hormonal birth control with them.)
I would suggest working between a good GYN that understands migraines and a migraine specialist that understands hormones.
posted by Crystalinne at 3:35 PM on August 15, 2022 [1 favorite]