Pregnancy and Migraine
Approximately 80% of women who have migraine stop having migraine attacks from the end of the third month of pregnancy until delivery. This is believed to be due to hormonal stability.
During pregnancy, medication use is discouraged unless absolutely necessary. Before using any medication for headache, a physician should be consulted. A non-medicinal treatment program can be effective in pregnancy.
Pre-Menstrual Syndrome – PMS
Migraine predominantly associated with menses is referred to as menstrual migraine. Headache can be a primary symptom of PMS. PMS is one of the more difficult conditions to treat and its headaches equally as difficult to manage.
If one is experiencing headache prior to, during, or immediately after menses, the use of nonsteroidal anti-inflammatory agents (compounds used to treat arthritis) ergotamine tartrate, or one of the triptans may be helpful in controlling these symptoms. In some patients, antidepressants such as fluoxetine are used to ameliorate PMS symptoms.
Menopause
One of the most frequently encountered triggers of migraine is changes in estrogen levels. As women progress through their child-bearing years, migraines often are more frequent. As menses cease in menopause, the majority of women experience fewer migraine attacks. However, it should be noted that hormonal replacement therapy sometimes causes women to continue with their migraines.
Nocturnal Migraine
Many patients who have migraine will experience their attacks during the middle of the night or early morning hours. This headache often awakens the patient from sleep.
Recent evidence suggests that these attacks are related to changes in neurotransmitters in the brain during sleep. It is recommended that patients treat the headache when the attack begins, elevate their upper torso (back, shoulders, and head) and rest or try to go back to sleep.
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