What is a Menstrual Migraine?
Menstrual Migraine (MM) is a neurovascular disorder1 caused by an underlying neurological condition that is thought to be triggered by the customary hormonal changes of a woman’s cycle. The WHO and the Global Burden of Disease study ranked migraine among the top most prevalent disorders in the world, and among the top seventh highest causes of disability worldwide2,3. About 50% of women with a migraine diagnosis also report an association with menstruation3,4.
The typical pattern for a MM episode occurs in the first days preceding or beginning of menstruation but some patients also report mid-cycle MM as well. Patients with menstrual migraine do not generally have hormonal abnormalities (as discussed in detail below)5.
Compared to migraines that may occur at other times of the month for such patients, MM can often be more severe, last longer, but don’t usually exhibit aura phenomenon. Nausea and vomiting are a common feature in MM as is an intense tiredness in the prodromal phase.
What is the Cause of Migraine?
On the surface, the cause may be attributed to chemical or hormonal imbalances stress, tension, fatigue, but in reality these are more accurately triggers and not “the” cause. In fact, oestrogen and progesterone fluctuations were naturally thought to be a cause, however current thinking by experts7 is that “abnormal central nervous system response to normal fluctuations in hormones is the likely underlying cause of menstrual migraine”7 and that “we must look at other factors (other than hormones)”7 for successful treatment.
So what is the real cause?
Thankfully, research is now revealing what every migraine sufferer knew all along, namely it’s not “all in your head!”5,6. In fact, what is emerging is the fact of a common pathway or “headache headquarters” in the brainstem where multiple neurons converge. This specific region is called the Trigeminocervical complex (TCC) and is a “holy grail” of sorts for both researchers and sufferers alike. Furthermore, recent studies have revealed that one of the most powerful causes of brainstem sensitivity is the upper neck or Cervical spine5,8,9.
Even between an episode or attack, research shows that all migraineurs exhibit a sensitized brainstem. This explains why otherwise normal stimuli (like hormonal changes) are registered by a migraineurs nervous system as a stressor or trigger for an attack…it is normal everyday stressors activating an already sensitized brainstem. Therefore, the real cause of the neurovascular event we call a migraine, is this underlying neurological condition.
During an attack an already sensitized brainstem (by the neck or other causes) is activated by a trigger, which then sets off an explosive positive feedback loop from the cortex and back to the brainstem. The already “cranky” hyper sensitized brainstem fires and the cortical brain cells respond with cortical spreading depression causing inflammation of the blood vessels, dura and local tissues.
The trigeminal nerve then picks up this amplified signal and becomes inflamed and sensitized itself lighting up pain in the face, head and scalp which then sends powerful signals back to the brain stem and the pain neuromatrix…and the vicious cycle continues amplifying and causing intense pain and multiple effects.
The good news is this brainstem sensitivity can be treated with an integrated and combined therapy approach, with a critical step being expert screening of the upper neck as a primary contributor of sensitivity in the brainstem3,4.
Our unique combined therapy approach is logical and evidence-based and aimed at decreasing the sensitivity in the brainstem at the “headache headquarters” with a number of safe treatment options individualized to your headache type.
Click the links for more information on how we perform Our Assessment or Our Treatment or to learn more about our revolutionary 4 phase S.T.E.P. into FREEDOM TM program to help you live life headache free!
- Goadsby PJ, Lipton RB, Ferrari MD. (2002) Migraine–current understanding and treatment. N Engl J Med 2002; 346: 257–70
- Vos T, Flaxman AD, Naghavi M, et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163–2196
- Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology. 2008 Apr 22;70(17):1555-63
- Lipton RB et. al. (2001) Prevalence and burden of Migraine in the United States. Headache 2001:41 646-657
- Watson D, (2015) “Sensitive New Age Migraine”; video lecture
- Goadsby, P,J, (2009) The vascular theory of Migraine. A great story wrecked by the facts. Brain, 132 (1), pp 6-7.
- Loder E. Current Treatment Options in Neurology 2001, Volume 3, Issue 2, pp 189-200
- Watson D. and Drummond (2014). “Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex””Cephalalgia. 54: 1035-1045. Doi 10.1111/head.12335.
- Watson, D. Drummond, P.D. (2012). “Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache”. Headache. 52: 1226-1235. Doi: 10.1111/j.1526-4610.2012.02169.x
The Headache + Migraine Clinic
Telephone: 1300 HOPE 4 YOU (1300 467 349)
Brisbane West (Springfield Central)
Suite 3, Level 1, Orion Springfield Central
1 Main Street, Springfield Central QLD 4300