Menstrual Migraine: Why It’s Not About Hormones

Cairns Headache and Migraine Clinic

Migraine is a common condition affecting approximately 15% of the population and women are 3 times more likely to experience migraine. Of these, 60% of female migraineurs have Menstrual Migraine.

Of all types of migraines, those associated with menstruation (and often midcycle) tend to be the longest-lasting, most severe, and the most confusing and difficult to treat.   It’s not surprising then that Menstrual Migraine is in the top 5 disabling conditions for women – Menstrual Migraine is a tough journey!

Historically, treatment has focused on artificially manipulating oestrogen levels. This is only natural because migraine or headache occurs around the time when there are the largest fluctuations of oestrogen (i.e. Day 1 and midcycle).  Because of this the assumption is that oestrogen is responsible.  But is it?

By definition (menstrual) migraine occurs on one side (and possibly swaps sides between episodes or within the same episode) of the head.  How can oestrogen be responsible for this? Fluctuating oestrogen levels are not going to affect one side of the head!

Furthermore, research has shown that the hormonal patterns (i.e. the degree and pattern of hormonal fluctuations) of women with Menstrual Migraine are no different to those who are do not suffer Menstrual Migraine. This has prompted a leading authority to suggest that Menstrual Migraine occurs because normal oestrogen fluctuations are misread by an underlying disorder in the central nervous system, and recent research has identified this disorder – a sensitised Brainstem, the same disorder as in Migraine.   

This recent development has significantly changed the treatment of Menstrual Migraine and involves specific anti migraine medication – the ‘triptans’ – which abort Migraine by DE-sensitising the Brainstem.   

Given that Menstrual Migraine and Migraine share a common underlying disorder i.e. a sensitised Brainstem, it is not surprising that the triptans have been shown to effectively abort Menstrual Migraine. However, this can be costly and unfortunately triptan medication does not prevent recurrence.

A potential source of Brainstem sensitisation is a disorder in the upper neck and there are signs and symptoms supporting this possibility.

Firstly, Menstrual Migraine is a one-sided headache, so is Cervicogenic (neck-related) Headache.

Secondly, a one-sided headache that can occur on the other side between episodes, or within the same episode, is a Cervicogenic Headache; this behaviour is often present in Menstrual Migraine.

The possibility that upper neck disorders are sensitising the Brainstem in Menstrual Migraine is further strengthened by recent research demonstrating significant neck abnormalities in women with Menstrual Migraine.

Given that Menstrual Migraine and Cervciogenic (neck-related) share similiar presentations, the presence of neck disorders symptoms in Menstrual Migraine, and that neck disorders can sensitise the Brainstem, it seems logical that a skilled examination of the neck occurs when investigating the cause of Menstrual Migraine.

For a skilled examination of the upper neck please call:  Proactive Physiotherapy 40536222