The hormonal migraine

migraine-caught-as-it-actually-hits-the-headache-phase-in-the-brain

I’ve hit a bad stretch of high-intensity migraines. Amplified by the lack of sleep due to the pain. Pain-lack-of-sleep cycle.

It started with menstrual migraines. Shhh I said menstrual.

2-4

These migraines are triggered by hormones during a woman’s cycle. Estrogen drops and progesterone.

They generally start 2 days prior to the cycle and usually 3 days in. Which is exactly how I am… now. I say usually because you can get ‘stuck’ in them, likely due to the whole lack of sleep issue, dehydration, and stress. Almost seems like what can happen is that it starts off hormonal and can go status. Or at least, that is how to seemed to me at my most brutal of stretches.

Here is the actual criteria: (I am the second one. I so have migraine with aura. But I also have migraine without aura. And vestibular migraines. Hormonal migraines, it is true, seem to be rather without aura, oddly enough. Although, extreme nausea for me, which is quite unwelcome.)

A1.1.1 Pure menstrual migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman,1 fulfilling criteria for 1.1 Migraine without aura and criterion B below B. Documented and prospectively recorded evidence over at least three consecutive cycles has confirmed that attacks occur exclusively on day 12 (i.e. days 2 toþ3)2 of menstruation1 in at least two out of three menstrual cycles and at no other times of the cycle.
Notes:
1. For the purposes of ICHD-3 beta, menstruation is considered to be endometrial bleeding resulting from either the normal menstrual cycle or from the withdrawal of exogenous progestogens, as in the use of combined oral contraceptives or cyclical hormone replacement therapy. 2. The first day of menstruation is day 1 and the preceding day is day 1; there is no day 0.
A1.1.2 Menstrually related migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman,1 fulfilling criteria for 1.1 Migraine without aura and criterion B below B. Documented and prospectively recorded evidence over at least three consecutive cycles has confirmed that attacks occur on day 12 (i.e. days2 toþ3)2 of menstruation1 in at least two out of three menstrual cycles, and additionally at other times of the cycle.
Notes:
1. For the purposes of ICHD-3 beta, menstruation is considered to be endometrial bleeding resulting from either the normal menstrual cycle or from the withdrawal of exogenous progestogens, as in the use of combined oral contraceptives or cyclical hormone replacement therapy. 2. The first day of menstruation is day 1 and the preceding day is day 1; there is no day 0.
A1.1.3 Non-menstrual migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman,1 fulfilling criteria for 1.1 Migraine without aura and criterion B below B. Attacks do not fulfil criterion B for A1.1.1 Pure menstrual migraine without aura or A1.1.2 Menstrually related migraine without aura.
Note:
1. For the purposes of ICHD-3 beta, menstruation is considered to be endometrial bleeding resulting from either the normal menstrual cycle or from the withdrawal of exogenous progestogens, as in the use of combined oral contraceptives or cyclical hormone replacement therapy.

 

So, okay, we have 5 days of extra migraine hormonal fun. However, I have found these to be the most brutal of migraines. For one thing, for me, they are One continuous migraine. Non-stop. For another, they are excessively high intensity. And thirdly, they are extremely difficult to treat. In my case, anyway.

I will say initially my cycle was longer and, as I said, I tended to get ‘stuck’ in longer stretches of these migraines. Then I gave the depo shot a go. Estrogen-based birth control is a no-go for me because I have migraine with aura. I gave the shot a go and it, unfortunately, made my vestibular migraines significantly worse. However, when I came off of it, my cycle has been less than half what it was. And since that, I have been straight up typical for this migraine type. No longer getting ‘stuck’ into it and generally looking at 4-5 days of hormonal migraines. And, damn, that is awesome. Otherwise, I had few options since I cannot take NSAIDs and I cannot take triptans daily.

Treatment is complicated due to the trigger. Birth control is an option. As is continued use of a NSAID during the duration. And continued use of a triptan during the duration. Something to carefully consider with a doctor or specialist for sure. Look at the highlight I put on treatment for an indepth analysis on treatments… the best by the way was triptan treatment.

 

 

 

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