Curse you, estrogen!

August 15, 2008 11:05 PM

You're not my docs, and I will call my doc on Monday and try to hammer out a solution. What the heck do you other female MeFites do for menstrually-related migraines? Anything really work for you?

I'm 32 and in decent health, aside from hypertension that's controlled by an ACE inhibitor and some stable but permanent eye problems from a car accident with associated medical anxiety issues. There is a long and nasty family history of migraine-- my mother got incapacitating migraines every single weekend when I was growing up, my sister gets three or four migraines a week, my grandfather had optical migraines and sometimes actual migraine pain.

Needless to say, I got 'em too-- first when I was 19 or 20, a full-on neurological migraine with numbness, slurring, visual disturbances, tunnel vision, you name it. I got off combined BCP and went on a beta blocker and the migraines remained a pretty rare occurrence-- maybe two or three in ten years, tops, usually under serious stress. (You ever do an eight-hour job interview while you couldn't feel half your body? And come in second for the job? Been there.)

Cut to two or so years ago, and the minipill-- which went fine for a year and then, wham, neurological migraines every night within three hours of taking my pill. I quit the minipill and they went away. Decided hormones were not for me and haven't gone near them since.

Now, though, I have migraines every time I'm ovulating or near my period-- combinations of visual disturbances, headache, and numbness. "Hormonal issue" immediately jumps to mind-- although I'd like to think I haven't hit perimenopause at 32, thanks!

(I'd also like to think that I don't have a blood clot or a brain tumor. Hence why my doc and I are about to have a chat about neurology consults and whether or not I need an MRI.)

Has anyone else had this sudden increase in migraine frequency? What did you do about it? What therapies did your doctor recommend, and how did they work for you? How do you cope with the inevitable "three days before my period, here comes the neurological freakout?" How do you reassure yourself that no, this isn't the time the brain tumor's come for your life?

Thanks, guys. I dunno what I'd do without strangers on the Internet to reassure me that my head's not about to pop off.

posted by fairytale of los angeles to health & fitness (31 comments total)

advil, vicodin or pot.
posted by hapax_legomenon at 11:13 PM on August 15, 2008

I suffered from menstrual migraines when I was on the pill. To directly answer your question, my migraines were not a sudden, naturally-occurring thing but started happening after starting the pill and always happened during the off week as some kind of estrogen withdrawal.

After some trial and error, I was prescribed Imitrex, which didn't always work. Then I was on Relpax, which almost always did work. Whenever I woke up with a migraine I would take a Relpax and 90% of the time it would be gone within an hour.

I stopped taking the pill for awhile and they stopped. Now I'm on Nuvaring and they have not returned, although I am also on a beta blocker now which might have something to do with it.

So, try one of the triptans like Imitrex. Relpax and Maxalt are others. The downside is that they are very expensive if you don't have insurance (Relpax was ~$10 a pill retail if I recall), although you doctor should be able to hook you up with some samples to try.

I have no idea if the ring would help with migraines that are due to natural hormonal fluctuations (instead of pill-induced ones) but it might.
posted by cabingirl at 11:37 PM on August 15, 2008

Seconding vicodin. I'll follow it with coffee if it's daytime and I can't afford to sleep, or just let myself conk out of it's night.

As for not freaking out over it being a brain tumor, use the soothing power of logic. Just repeat to yourself in a very calm tone, "It wasn't a brain tumor the last time it happened, which also coincided with the exact same time of the month. Therefore, it isn't a brain tumor this time." Then wait for the delicious vicodin to kick in.
posted by scody at 11:58 PM on August 15, 2008

Heh. I'm actually *allergic to Vicodin,* because there is no God. Were I not, I think I'd be hittin' it now. :)
posted by fairytale of los angeles at 12:15 AM on August 16, 2008

A strong cup of coffee and/or two aspirin and/or a hit of pot.
posted by ottereroticist at 12:25 AM on August 16, 2008

You don't mention trying triptans, which are usually the first course of treatment for migraines. Assuming there's no conflict with any other medications you are taking, they could change your life. I get occasional migraines (unrelated to the menstrual cycle, but still) and take Imigran when I feel one starting. It usually gets rid of the migraine in less than an hour. Imigran is a prescription drug in the US but available OTC in the UK.

I'm shocked that someone would suggest Vicodin as a first course of treatment for migraines when triptans are so much safer and more specific to migraines. Triptans are not pain medicines as we usually think of them; rather they are selective serotonin receptor agonists. I can only imagine using heavy-duty painkillers for migraines if triptans didn't work--and there are a bunch of triptans you can try, so if the first one doesn't work, your doctor can prescribe another.
posted by Violet Hour at 12:35 AM on August 16, 2008

Violet Hour, I only recently got medical insurance back, and my doctor and I agreed to watch the migraine issue and re-consult if it got worse, which it has. Hence, no triptans yet. I expect they'll be on the list of options-- my sister managed to develop some sort of immunity to Imitrex and then ended up on Maxalt, and then they had to go to other options altogether. My mother shied away from medications other than beta blockers for *years,* much to everyone's general distress, and seems to do mostly OK on Imitrex.

I'd love to find something that just works. (Pot is probably also out, despite living in CA-- I have various eyeball issues that may not respond well to drug-induced changes in intraocular pressure, and the few times I've been smoked up in someone's presence, it's made my anxiety *worse,* which I find kind of weird. Not trying to pull "asks for advice, argues with respondents," just have a sort of weird set of med interactions.)
posted by fairytale of los angeles at 1:16 AM on August 16, 2008

I'm male, but I used to get migraines from time to time. My solution was to be very aware of the warning signs (numbness in fingers, tunnel vision, spots), and then immediately get myself into a shower. I would turn the lights off, run the shower at body temperature or slightly below, and lay down in the shower with a facecloth over my face (otherwise drops up the nose were annoying). If I did this within about 20 minutes of the tunnel vision starting, my migraine would be gone in under 1/2 hour. The noise was a little tough to deal with at first, but after that I'd be fine. My totally non-medical thinking is that the temperature helped regulate blood pressure slowly, thus reducing the pain.

The nuclear option was a shitload of Tylenol 3's and passing out in a pitch black bedroom. I liked the first option a lot better.
posted by dirtynumbangelboy at 1:45 AM on August 16, 2008

I don't want to sound dumb given the other medications you've taken and are familiar with, but have you tried Excedrin Migraine? I started getting more frequent and more regular migraines, more or less monthly, after I had a baby and always at the same time of day, which led me and my doctor to think they were hormonal (I was not on hormonal BC). I did have an MRI (no tumor, etc., etc.) and I tried to manage things with diet and relaxation even though doc suggested Excedrin. I believe I actually laughed at her. But it worked, and since using it I've run into other long-term migraine sufferers and it's like a secret handshake--"hehe, Excedrin Migraine oh man that stuff rocks!"
posted by cocoagirl at 2:38 AM on August 16, 2008

My favourite is Nimesulide, but it's been pulled off the market (at least in Europe). The thing with migranes, though, is that a drug that worked wonders one day might not work at all the next. Triptans make me nauseous and don't really work all that well.

A neurologist told me that there are a few things I should remove from my diet completely: citrus fruits, alcohol, and chocolate. He also advised eating a plain yogourth first thing in the morning. I haven't been able to follow this completely, but I have a (brave) friend who did, and she claims she now gets one migrane a year (down from about one a month).
posted by neblina_matinal at 3:56 AM on August 16, 2008

All my sympathy - I'm undergoing a sudden increase in seemingly-hormone-related migraine frequency myself and desperately waiting for my doctor's appointment next week, so I really do feel your pain. For what it's worth, while I am waiting for the appointment, I am having more luck with Excedrin Migraine than I ever did with anything else over-the-counter. I have to take it pretty early in the migraine, but as long as I take it right away, there seems to be a lot less pain and it's over with more quickly. I'll come back next week if my doctor comes up with any suggestions that aren't already listed here.
posted by Stacey at 4:29 AM on August 16, 2008

I asked this question more than three years ago. I'm THRILLED to report that the remedy the neurologist suggested (atenolol, anaprox and Relpax, as detailed in my last post) still works. I would add that the gynecologist changed my BCP prescrption to Estrostep in an effort to alleviate the sharp drop-off in estrogen on the second day of my period, which was when I usually got the worst migraine.

These days, I occasionally get a headache on the fourth day of my pill cycle and on the Thursday of my menstrual week, but if I take my medicine quickly - at the "uh-oh" moment, as we've come to say - it seldom escalates to needing the Relpax or needing to go to bed or wanting to stab my eye out with my thumb. When it does, Relpax usually does the trick in 15-20 minutes.

Good luck!
posted by SashaPT at 5:24 AM on August 16, 2008

A few things that have worked for me when I've tried to avoid heavy drugs:
1. Vicks Vap-O-Rub of Metholadum -- just under your eye -- DO NOT let it get in your eye. Somehow it operates as a counter irritant and helps "fool" pain sensors.
2. Ice pack (or baggie filled with ice) - on back of neck at base of skull.
3. warm bath with warm shower running simultaneously -- yes I know it's wasteful -- but it helps. If I had to opt for one or the other I would do bath with pitcher to pour water.
4. Turn thermometer down -- go to bed in dark room.

Excederin Migraine -- believe it or not has enough kick to sometimes forestall headache progression -- I totally agree with Sasha on that.

Good luck --
posted by peace_love_hope at 6:30 AM on August 16, 2008

A combo of dirtyboy's and cocoagirl's and peaceandlove's suggestions has worked for my menstrual-related migraines, which only occur a few times a year under greater than normal stress.... as soon as I get the first symptoms, which include the spotty vision and numbness (and the beginnings of a headache, obviously), I get into bed with earplugs and a cold, cold cloth on my head, or even an icepack. A handful of Excedrin Migraine and some Sominex so that I can sleep through most of it... that's what has worked for me. Fortunately, the last few times I've had one, it's been on a weekend or an evening, or my boss was kind enough to let me race home before it got really bad. Oh, and keep some of your drug of choice in your work desk, by the way, that has saved me on several occasions.
posted by potatopeople at 6:51 AM on August 16, 2008

Ditto on what potatopeople said about keeping your meds with you - not just in your desk but in your purse. I took an old Altoids container and now have it stocked with Advil, Tylenol, Excedrin and my prescriptions.
posted by Sweetie Darling at 8:24 AM on August 16, 2008

I agree with the Excedrin suggestion. I never leave home without it. You might need three instead of two. It has cured all of my headaches, and nothing else helps them much at all. I think regular Excedrin is either the same as or equally effective as the migraine-labelled variant, but am not sure. Regular Excedrin works like billy-o, though. Get thee to a drugstore.
posted by theredpen at 9:16 AM on August 16, 2008

My girlfriend gets botox injections for her migraines.

Is is injected into her eyebrow area, her forehead, and back of the head near her neck.

It's really the only thing that works.
posted by Zambrano at 9:31 AM on August 16, 2008

I think regular Excedrin is either the same as or equally effective as the migraine-labelled variant, but am not sure.

Excedrin Migraine is exactly the same product (250 mg acetaminophen, 250 mg aspirin, 65 mg caffeine) as Excedrin Extra Strength.
posted by jamaro at 10:18 AM on August 16, 2008

I'm also prone to hormone related migraines, like 90% of the people here ;) Mine are the migraine with aura kind, which bring with them a whole array of strange effects like numb hands, panic attacks, the inability to remember my own name, sunspotty vision and a ravenous desire for red meat afterwards.

Nthing Excedrin taken as soon as you have start having warning signs. Most of the time this takes care of it for me, but sometimes I can't head it off, as it were, and am debilitated for at least 4 hours. In those cases I take a homeopathic migraine preparation, plus Excedrin, plus a nap in a dark room with a blanket pulled over my head. (INNAD but some studies show that it reduces the incidence of migraine.) It might be the placebo effect but still it works. Who cares as long as I can feel my hands, right?
posted by fiercekitten at 11:18 AM on August 16, 2008

If beta blockers have worked in the past why not go back on them? Seems a bit counterintuitive to me to go through another round of Find.The.Right.Medication with all of the potentially nasty side effects and, taking meds that might not work in the long run.

Has anyone else had this sudden increase in migraine frequency?

I did in my early 20's. I went from rarely having them to upwards of three attacks a week punctuated by a never ending low grade headache the rest of the time. When I was put on Sibelium all migraines and headaches ceased but, over time I developed shakes and twitches so I had to go off of it. Now I'm back at square one (Tylenol #3 and ice packs) while I wait to see a neurologist.

The other thing that might help is acupressure. Take your thumbs and place them on either side of your spine at the base of your skull and press while tilting your head back into your thumbs. It'll hurt at first but the pain should subside. There are other spots you can try but that one works the best for me.

I'm shocked that someone would suggest Vicodin as a first course of treatment for migraines when triptans are so much safer and more specific to migraines.

Safe is relative, I found out the hard way that I'm deathly allergic to Imitrex. And, if you're getting more than one migraine a week they're not the best drug to be taking plus, they cost an arm and leg.
posted by squeak at 11:54 AM on August 16, 2008

I'm including a vote for Riboflavin...my neurologist suggested it when betablockers and triptans had no effect. I didn't take it in the high doses used in this study. I believe I was taking just 100 mg daily with excellent results. ( Now, I'd use the higher 400 mg dose used in that study, based on their results) Not all of my migraines occurred around my monthly cycle, but that was the most common time...I had no complete migraines after beginning Riboflavin (vitamin B-2)--although I occasionally had the aura minus migraine pain until I was past the age of the monthly cycle (hooray!).
posted by mumstheword at 2:00 PM on August 16, 2008

dang! why didn't the Riboflavin study link Let's see if it works this time.
Sorry!
posted by mumstheword at 2:11 PM on August 16, 2008

link http://www.cfpc.ca/cfp/2003/Oct/vol49-oct-critical-1.asp
posted by mumstheword at 2:12 PM on August 16, 2008

My standard answer for headache-related questions, because it helped me immensely:
Heal Your Headache, by David Bucholz

That being said, what ended up working for me was Verapamil. It's a calcium-channel blocker, so it'll also help your hypertension.

There are also several anti-depressants that I tried, as well as different pain killers (but not triptans, they're a no-no for me due to decreased blood flow in my brain). Also, there's the usual strategy of eliminating other migraine triggers (as discussed in the book), so that the triggers you can't control (ie that time of the month) don't themselves cause a migraine.
posted by cgg at 3:48 PM on August 16, 2008

Have you talked to your doctor about possibly trying Topamax for a while? I was at the end of my rope, getting three-four day long migraines every couple of days. I tried Imitrex and it didn't do much (I'm already on beta blockers for tachycardia). I, too, found a direct correlation between my hormonal cycle (as well as barometric pressure). I was a lunatic if it was the wrong time of the month and a fucking rain storm was coming along! Anyway...

My current protocol is 50mg of Topamax twice a day (morning/night), and then 800mg ibuprofen if I feel a headache coming on. If the headache doesn't respond to the ibuprofen within 20-30minutes, then I take 5mg Maxalt-MLT. The Maxalt is kind of like a super-melty Altoid. It dissolves as soon as you put it on your tongue. Usually, this will knock out any headache in about 15 minutes.

On the rare occasion that it *doesn't*, then I hit the narcotics (I can also repeat the Maxalt a couple hours later). I'm now down from 9-10/month to maybe 1 headache every couple of months.

Just know that it does take a while to ramp up on the Topamax. I think it was about two weeks for me to get up to the 100mg I'm at now. The stuff isn't cheap (even with insurance, I think I pay about $35/mo copay), but it's really made a huge difference in my life. I will tell you that there tend to be small cognitive side effects (usually memory stuff), but I really don't seem to notice them anymore.

Good luck. I've so been there.
posted by dancinglamb at 4:07 PM on August 16, 2008

Medstudent filter: you mentioned using a Betablocker before, they are generally for prophylaxis (inderal/propanolol), I'd either go back to it, or maybe a "triptan" drug which are specifically for migraines. Imitrex (sumitriptan) is a good one, and the prototype of the class basically. For those I've seen on it, it seems to work well.
posted by uncballzer at 6:13 PM on August 16, 2008

Warning to those without prescription insurance - triptans are expensive. My Relpax is about $24 a pill. I've found it as low as $20/pill (at Walgreen's for a $20 annual fee for a single person.)

Until you can get to your doctor for some pain meds, triptans, and perhaps some Phenergan/Compazine if you have nausea and/or vomiting, here's what helps me (and by help I mean until the pain meds and Relpax kick in - these methods aren't enough for my migraines):

No looking at screens of any kind (once the pain starts to subside, I can watch TV, but not use the computer)

Cold wet washcloth on the back of my neck

Gently massaging my forehead

Your OTC painkiller of choice

Emetrol and/or ginger chamomile tea for nausea/vomiting (I'd love to try Queasy Pops or Queasy drops but haven't gotten around to ordering them yet.)
posted by IndigoRain at 6:26 PM on August 16, 2008

Feverfew capsules every day worked for me. Has worked for some friends, not for others.
posted by QIbHom at 8:23 PM on August 16, 2008

Thanks, folks. I've acquired a bottle of Excedrin Migraine and will phone up my doc about any other prescription measures she thinks I should take. I've also seen some articles about trying prescription doses of NSAIDs during the premenstrual week, which sounds promising-- I'd been on prescription doses for my back over the late spring, and weaned off this summer before the migraines started.

As regards beta blockers, even small doses of propanolol made me gray out whenever I stood up (orthostatic hypotension-- a glorious 80/50 or lower every time), which was why I eventually had to come off them. Passing out every time you've got to answer the phone in a hurry is a no-op, but at least I'll never get my ass kicked out of the Olympic shooting competition.
posted by fairytale of los angeles at 9:49 PM on August 16, 2008

I was getting knocked out by hormone related migraines...tried acetaminophen, ibuprofen, combinations of the two...nothing worked. Then I read somewhere that with that particular type of migraine, Aleve was the (OTC) drug of choice...sure enough, it has worked for me. Doesn't always get rid of it completely, but definitely brings it down enough for me to function.
posted by kattyann at 4:44 PM on August 17, 2008

Followup: saw my doc today and got told "take an Aleve, and two Tylenol with it, as soon as you have an aura. If that doesn't work, hit it with one of these an hour after that."

Apparently my doc is not down with the use of triptans for neurological migraine, due to that "insufficient blood flow to head during attack" issue.

However, four cups of coffee, two Tylenol, and an Aleve did for me pretty well yesterday-- I stayed in work and all-- so I guess I'll see how the Cafergot goes. Thanks again, gang.
posted by fairytale of los angeles at 12:00 AM on September 13, 2008