How I Cured My Menstrual Migraines

How I Cured My Menstrual Migraines

Some of you may not know that one of the best gifts fertility awareness ever gave to me was helping me sort out a ten year battle with a debilitating chronic illness. I've suffered from migraines since 2009, and it's been really hard. Now I'm finally coming out of it, and I want to share what I learned on my journey to self-healing.

I (somehow) got through college and started my business despite having attacks 2-4 times a month. Thats 24-48 migraines a year. Honestly, partly why I chose to work for myself, even though its much harder and less money, is that my flexible schedule allowed me to work when I could, and not be in a situation where I could abruptly lose my job because of having chronic migraines. 

Usually, they would last 12-18 hours and  I was sluggish and exhausted the entire next day. For the first few years of dealing with chronic pain, I visited my western doctor, who told me absolutely nothing. "We don't know why they occur" "try Excedrin migraine, otherwise we can prescribe you a prescription grade pain killer." I didn't find these so-called answers to be acceptable, but I tried several over the counter options, which never even put a dent in the pain. The most helpful option I had was smoking cannabis, but even that didn't always help. 

Then I went on the pill in 2014. My doctor never warned me of the risks, even though my medical history form indicated that I had chronic migraines. I was sadly prescribed a combined oral contraceptive, which made my migraines more painful, and they began to occur in increased frequency. You can read about a scary migraine episode I had in my first month of using the pill here.

So let's get into some info about migraines and what we can do to prevent them.

What is a migraine, and how is it different from a headache?

A migraine is a spectrum of headaches associated with either vascular constriction or dilation. The pain is contained to one area of the head with a pulsing pain, often in one of the temples, whereas a headache is generally pain throughout the head area. There are also other symptoms like nausea, vomiting, and sensitivity to light, and sound. Unfortunately migraines are not well understood and need to be studied more (especially considering how many people are suffering), but the main theory is that there is an imbalance in serotonin metabolism. This causes cerebral arteries to dilate, and spasms to occur in the extra-cranial blood vessels.

There are a couple different types.

Classic migraines - These have some warning before they begin. They usually contain an "aura" which is a state of altered vision, sometimes a cloudy or flashing light is visible in your view. You may experience nausea and light/noise sensitivity.

Common migraines - These begin more slowly than classic migraines, but you may feel some symptoms of depression, tiredness, or opposite feelings of hyperactivity and anxiety beforehand. This type of migraine has no aura, but the symptoms are generally the same.

I can't say that either of these exclusively define me, and that's ok, these are just guidelines for a poorly understood condition.

What is a menstrual migraine?

A menstrual migraine has the same symptoms as regular migraines. It is simply called 'menstrual' to denote its relationship to the menstrual cycle, and menstrual cycle hormones.

There are a couple different types of menstrual migraines.

Pure Menstrual Migraines - Migraine attacks that occur exclusively  just before, or during menstruation, and at no other times in the cycle. (Roughly 10% of menstruating people with migraines)

Menstrually-Related Migraines - Migraine attacks that occur most often just before, or during menstruation, but also at other points in the cycle. (Most common)

End Menstrual Migraines - Migraine attacks occurring at the end of the menstrual bleed (example: days 5-6-7), caused by menstrual blood loss. These should be treated with iron supplementation. Further study is needed.

I would put myself in the menstrually related migraine category, which is going to be the case for most people.

How migraines are connected to menstrual cycle hormones

Studies show that migraines can be triggered by a drop in estrogen. This is why the pre-menstrual (luteal) phase is often the most likely time to experience a migraine. One study showed that day-to-day hormone levels were similar for people with migraines and controls, but that there were "significant differences in the rate of estrogen withdrawal that were phase-specific (late luteal) and time-specific (2 days post peak)" [1] This means that the drop in estrogen that occurs around ovulation, as well as the final drop in estrogen which occurs before bleeding, are both trigger times for migraines. 

This has been congruent with my experience. Through FAM charting, I've figured out that the majority of my headaches seem to occur around ovulation (when estrogen is dropping), or right around the time of bleed (either the day before, or day 1 or 2). See this displayed visually in the chart below.

[1]

Another possible hormonal connection is the presence of inflammatory prostaglandins in the days leading up to and during menstruation, especially those who experience menstrual pain and heavy bleeding. Studies show that "prostaglandins dilate intra-cranial and extra-cranial arteries and cause headache in healthy volunteers and migraine-like attacks in migraine patients." [2] This suggests that addressing menstrual pain may also play a part in discouraging the frequency and severity of menstrual migraines. 

This has also been true to my experience. As I cured my menstrual cramps over the last few years, I've seen a reduction in migraine attacks.

Migraines and Deficiencies, Allergies, and Toxin Exposure

Attributing migraines to the menstrual cycle hormones seems to make sense - but what if this isn't the whole story? I find that this is a convenient diagnosis that is sometimes to the detriment of an individual patient and their needs. There are other factors at play besides the menstrual cycle hormones, even if you suffer from menstrual migraines. 

Mineral Deficiency - At least 50% of people with migraines are magnesium deficient. [6]  Magnesium is an essential mineral for many intracellular processes, and affects serotonin receptor function, and the release of many different types of neurotransmitters. Blood tests are a poor way to measure magnesium stores, and thus they cannot be used to accurately identify deficiency. [7] "According to recent estimates, 48% of Americans consume inadequate magnesium from food... the widespread use of aggressive farming practices, such as heavy pesticide application, has depleted the soil of magnesium on many commercial farms. As a result, food grown in these soils is often magnesium-deficient. Organic and biodynamic farms typically have higher magnesium in the soil, which is then taken up by the crops, so when possible, source your food from small farms where attention is placed on soil fertility. [8] One study shows that "Intravenous magnesium reduces acute migraine attacks within 15 - 45 minutes, 120 minutes, and 24 hours after the initial infusion and oral magnesium alleviates the frequency and intensity of migraine. Intravenous and oral magnesium should be adapted as parts of multimodal approach to reduce migraine." [13]

Allergies - Migraines may be triggered by certain food sensitivities, namely foods with aspartame, sodium glutamate, or benzoate. Food allergies can be very individual, so look for other signs that these foods are harmful such as rashes, acne, and other gastrointestinal symptoms. Gluten is commonly discussed as a trigger, but it could possibly be attributed to an association with pesticides commonly used on wheat such as glyphosate, though more research is needed. In my own experience I found that cutting out gluten did not affect my migraines, but studies have shown it may lessen migraine attacks.

Water and Air Quality - We don't talk enough about how our environment is connected to migraines. In the case of tap water, the quality of water you have access to can make a big difference in your wellness. Chlorine is responsible for magnesium depletion in the body, commonly found in tap water. Fluoride has been shown to accumulate in the pineal gland. This gland "stores brain serotonin, produces melatonin, and regulates the sleep cycle" — all components connected to migraine attacks. Lastly, tap water is contaminated with all kinds of pharmaceuticals and other chemicals. Use the EWG Tap Water Database to see what's in your municipalities water. In 2016, I switched to using a Berkey filtration system for all drinking and cooking water for waterborne contamination removal. [4]

In 2010, American Society presented the findings of a study into a migraine and pollutants and found that "Migraines sufferers are at greater risk of attacks on poor air quality days... traffic-related gaseous pollutants may be associated with higher odds of migraine headache onset in cold season." "Various air pollutants, including lead, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matters (PM10 and PM2.5), are known to have positive association with migraine intensity, frequency, and duration, as well as the rate of doctor visit due to migraine attack." [5]

Migraines and contraceptives

If you are ever offered contraceptives as a way to "treat" menstrual migraines, my advice is to *run* - Here's the deal. Shutting down the menstrual cycle with contraceptives is not going to address the root of your migraine pain. Even if your menstrual cycle is causing migraines to happen on a cyclical basis, they are likely to worsen on any combined hormonal contraceptive that contains estrogen. 

One study found that "The joint effect of combined hormonal contraceptives and migraine with aura was associated with a 6-fold increased risk of ischemic stroke compared with neither risk factor. Use of combined hormonal contraceptives did not substantially further increase risk of ischemic stroke among women with migraine without aura." [3]

After learning this, and having had my own frightening experience with the worst migraine of my life the first month that I used the pill, I'm horrified that my doctor didn't give more thought to prescribing me a pill containing estrogen. This is something to consider if you are currently using hormonal contraceptives and suffering from migraines.

The importance of a preventative regimen for migraines

The most important change I made regarding my migraines was to change my perspective on how to deal with them. I needed to stop thinking about treating the pain and to start to investigate the root causes. If at all possible, consulting with an herbalist, naturopath, Chinese medicine practitioner, acupuncturist, or Ayurvedic may be able to help you more than the western doctor. Their approach is to treat the root imbalances, and can offer you more individualized insight. With that said, I want to share what I've learned about earth medicine and it's usefulness for treating migraines. Thankfully, there are some studies to refer to here.

Magnesium - This is the big one which I've already touched on above. Magnesium "calms your nervous system, reduces inflammation, and stabilizes serotonin receptors. Magnesium also prevents the release of substance-P, which is a pain-promoting neurotransmitter involved in migraines." [6] You can be aggressive, taking anywhere from 300 to 600 mg daily before sleep. The best bioavailable forms of magnesium are glycinate or citrate. Epsom baths and transdermal magnesium spray are also good choices for magnesium absorption.

Vitex Agnus Castus  - Protects hypothalamus from chronic stress and contains opiate like constituents which calm your nervous system. "Migrainous women with PMS were enrolled in the study and advised to assume a treatment with VAC (40 mg/day) for PMS for a 3-month period. Effects both on PMS and headache were assessed. Out of 107 women, 100 completed the 3-month treatment for PMS. Out of them, 66 women reported a dramatic reduction of PMS symptoms, 26 a mild reduction, and 8 no effect. Concerning migraine, 42 % of patients experienced a reduction higher than 50 % in frequency of monthly attacks, and 57% of patients experienced a reduction higher than 50 % in monthly days with headache. " [9] Try 25 days on, 5 days off during the follicular phase (after menstruation ends but before ovulation). The most important time to use Vitex is the premenstrual phase. 

Riboflavin (Vitamin b2) - Normalizes the production of serotonin and improves the function of a gene called MTHFR that has been linked to migraines... has also been shown to reduce the frequency of migraines by 50% [6]  Another study could "demonstrate a significant reduction of headache frequency following riboflavin treatment. In addition, the number of abortive anti-migraine tablets was reduced. In line with previous studies our findings show that riboflavin is a safe and well-tolerated alternative in migraine prophylaxis." [10] Try starting with 200 mg, twice daily.

Melatonin/Chinese Skullcap - Reduces inflammation and stabilizes serotonin and GABA. "Melatonin is an upstream antioxidant; many of its metabolites, created when our bodies process it or when the plant compound detoxifies oxidants, are also potent antioxidants. It is also synergistic with a number of antioxidant enzymes and other antioxidants such as vitamin C, vitamin E, and glutathione... Using plants high in melatonin (which is more effective than using melatonin supplements) can normalize the circadian rhythms, including the sleep cycle, and reduce inflammation in the brain and CNS. The constituents of Chinese skullcap do enter the plasma in substantial amounts. Baicalein is strongly concentrated in the lungs, brain, and hippocampus, wogonin in the liver, kidneys, and lungs. Baicalin concentrates in the brain, specifically in the striatum, thalamus, and hippocampus. Many of their metabolites are strongly present in those locations as well. [12] Try Chinese Skullcap tincture, or .5 - 3 mg of melatonin supplement before bed.

Milk Thistle - Most people have never heard of the liver-migraine connection. I hadn't, until two different naturopaths and an herbalist brought it up to me. The liver is the organ that metabolizes and detoxifies substances that enter the body. Serotonin is metabolized by the liver. By improving liver function and normalizing serotonin metabolism, the frequency and severity of migraine headaches may be reduced. Try Milk Thistle tincture once daily.

Thanks for reading! I hope this post can help you start healing your migraines. They are truly the worst, and I'm here to support you on your journey! Ask me anything in the comments.

Citations:

[1] Sex hormones in women with and without migraine. Evidence of migraine-specific hormone profiles. Jelena M. Pavlovic, MD, PhD, Amanda A. Allshouse, MS, Nanette F. Santoro, MD, Sybil L. Crawford, PhD, Rebecca C. Thurston, PhD, Genevieve S. Neal-Perry, MD, PhD, Richard B. Lipton, MD, and Carol A. Derby, PhD

[2] Prostaglandins in migraine: update. Antonova, Maria; Wienecke, Troels; Olesen, Jes; Ashina, Messoud

[3] Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Author links open overlay panel. Steven W.Champaloux PhD, MPH, Naomi K.Tepper MD, MPH, Michael Monsour PhD, Kathryn M.Curtis PhD, Maura K. Whiteman PhD, Polly A.Marchbanks PhD, Denise J.Jamieson MD, MPH

[4] https://blog.themigrainereliefcenter.com/can-tap-water-cause-migraines

[5] Dr. Elizabeth W. Loder, Associate Neurologist, Brigham and Women’s Hospital Associate Professor of Neurology, Harvard Medical School

[6] Period Repair Manual, Lara Briden

[7]  Why all migraine patients should be treated with magnesium. Mauskop A1, Varughese J.

[8] Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition, Lily Nichols

[9] Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation. Ambrosini A1, Di Lorenzo C, Coppola G, Pierelli F.

[10] High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Boehnke C1, Reuter U, Flach U, Schuh-Hofer S, Einhäupl KM, Arnold G.

[11] Herbal Antivirals: Natural Remedies for Emerging & Resistant Viral Infections. Stephen Harrod Buhner, Storey Publishing, LLC.

[12] The Combined Effects of ω -3 Fatty Acids and Nano-Curcumin Supplementation on Intercellular Adhesion Molecule-1 (ICAM-1) Gene Expression and Serum Levels in Migraine Patients. Soveyd N1, Abdolahi M1, Djalali M1, Hatami M1, Tafakhori A2, Sarraf P2, Honarvar NM1.

[13] Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials. Chiu HY1, Yeh TH2, Huang YC3, Chen PY3.