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March 16, 2015 6:32 PM   Subscribe

I have bad PMS or PMDD symptoms lasting two weeks out of every month. Hormonal birth helps a lot, but also causes frequent migraine headaches. Where do I go from here?

30 year-old woman here. Nuvaring really helped my PMS! However, I came off Nuvaring in December after two solid months of migraine headaches with no aura. While my headaches are mostly gone now, PMS is rearing its head again. For 2 of every 4 weeks, I have an hard time handling my day-to-day routine due to emotional and physical symptoms. I've taken a lot of PTO at work and it's interfering with my interpersonal relationships.

I tried and found no relief from SSRIs (low and high doses of Zoloft). I have tried and rejected various birth control formulations -- no to Lo/Ovral, Nuvaring and Yaz. I'm thinking about asking to try Seasonale, but should I even be on a hormonal birth control if I am prone to migraine headaches?

I'm worried that if I go to to yet another OB/GYN, they'll just throw more shit the wall to see what sticks. Is that the only solution here? I need to know what didn't work about the other medications I've tried, so I don't just try another brand of the same thing. What blood tests or hormonal tests should I ask for? Is it too much or too little progesterone or estrogen that's my problem? Am I going to get a blood clot and die if I try another birth control and add a migraine medication to the mix?

It really feels like these two ailments, PMS treated with hormones and migraine caused by hormones, do not have a common treatment. Help please! What should I ask my doctor in the fifteen dismissive minutes I'm allotted? How do I advocate for myself in this situation?
posted by theraflu to Health & Fitness (11 answers total) 4 users marked this as a favorite
Have you considered a hormonal IUD? Straight shot of hormones straight to your babymaker means the rest of your body has less hormone to deal with. It might be something that works better for you. Mirena is a great solution for a lot of women with negative side effects from typical HBC.
posted by phunniemee at 6:38 PM on March 16, 2015 [4 favorites]

I think at this point you ask to be referred to a reproductive endocrinologist for an in-depth hormonal workup, with that particular specialist evaluating the results.
posted by Iris Gambol at 6:39 PM on March 16, 2015 [1 favorite]

I swear by Zovia. I've tried all the ones you have and only Zovia fixed my migraines, PMS/PMDD, etc. That being said, it may be that the migraines are exacerbated by your PMS/PMDD, but not CAUSED by them. Have you talked to any doctors aside from your OB/GYN?
posted by Hermione Granger at 6:45 PM on March 16, 2015

Response by poster: Yes -- the Zoloft was prescribed by my psychiatrist, and I've seen a general practitioner as well. Bouncing around cities and the state of healthcare have made it difficult to stay with a single doctor.
posted by theraflu at 6:48 PM on March 16, 2015

I have migraines -- but my Mirena seems to have fixed them. I get them maybe once a year now instead of once a month or so.
posted by KathrynT at 7:18 PM on March 16, 2015

Medicinal botox shots have significantly helped my migraines; you might try those and then go back on hormonal birth control.
posted by vegartanipla at 9:20 PM on March 16, 2015

Have you had your magnesium levels tested? Though I understand it's hard to detect a deficiency. Carefully supplementing with magnesium might help both your migraines and your PMDD symptoms.

(Sorry I can't cite research for the migraines/magnesium link right now, and I don't think there's a lot of research behind magnesium/PMDD. Personal data point: out of desperation, I tried magnesium supplementation for my period symptoms, and it made a big difference. My cluster headaches - which I know aren't migraines, and which come and go, so grain of salt - also completely disappeared after I started taking it.)
posted by moira at 9:49 PM on March 16, 2015 [1 favorite]

Just as a data point, my Mirena did not fix PMDD issues for me, it just made them harder to pinpoint since I wasn't bleeding. Neither did the Nuvaring. Seasonale (taken with no sugar pills) stopped it 100%, it was a revelation.

But you may be sensitive to different hormones than I am... I tended to have most trouble around ovulation and at the end of the cycle, which makes me think I'm extra sensitive to fluctuations in estrogen. I'm thinking the pill worked for me because it stopped the ovulation cycle completely, and the added estrogen helped keep that level too. (By contrast, Mirena only partially suppresses ovulation.)

My understanding about oral contraceptives is that they put you at some additional health risks if you have migraine with aura, but not otherwise. And you might find that you have fewer headaches on something like Seasonale, where there's no off period. But this is obviously something to talk with your doctor about.
posted by wyzewoman at 8:24 AM on March 17, 2015

There's a pretty standard female hormone panel that gets given when PCOS is suspected; that covers a lot, if not quite the kitchen sink. I think it covers estrogen, progesterone, androgen, FSH/LH… and a whole mess of other stuff. Try asking for that.

And definitely ask to get referred to an endocrinologist; you want someone who specializes in this, not your GP.

What helped me was taking spironolactone to help with the androgens; using a plain old copper IUD with no hormones; and switching to a ketogenic diet. Now instead of being in hell for 10 days a month, I get one migraine a month. It's still not perfect, but man, it's worlds better. WORLDS.
posted by culfinglin at 11:20 AM on March 17, 2015

Just wanted to suggest another approach to supplement meds/hormones: While I wasn't at your level of pain, I used to have mild PMS followed by miserable cramps and usually a migraine somewhere in the middle. I had always assumed this was just one of the joys of womanhood (yay!). Then, when I was seeing an acupuncturist for other issues, she offered to try and treat my symptoms. It took a few sessions to get everything in line, but after that, I would just have one monthly "maintanence" appt. No PMS, no cramps. It may not work for you, but it could be something to consider trying...
posted by jenquat at 7:45 AM on March 18, 2015

This is anecdotal, but I used to have migraines a few times a month and a few of years ago, I went on a low carb diet. I didn't have a migraine for the entire time I was on that diet. I'm no longer on a low carb diet, but the migraines have never really come back. I get bad headaches, but I've only had one migraine in over a year, and it was recently and possibly due to a new birth control I'm on.

I agree with the folks talking about a Mirena IUD. I've had one, that didn't work out for other reasons, but it definitely didn't trigger migraines like some of the hormonal BC I've been on in past years.

I've also had the above mentioned copper IUD. It was great for about a year and a half, and then my periods got really heavy and the cramping increased tremendously and it hasn't ever lessened, even though I don't have the IUD anymore. Again, all anecdotal.
posted by persephone's rant at 8:40 AM on March 19, 2015

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