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Menstrual Headache: Cause and Diagnosis of Menstrual Headache
Menstrual headache affects 25% of women during reproductive years. Around 60 to 70% women relate the headache or migraine to the menstrual period. True menstrual migraine occurs during the second day before and end of the menstruation and a 14% population of migrainuer are affected by this disorder. Menstrual migraine, which occurs between 7th day before to 3rd day before is considered premenstrual syndrome (PMS) headaches and the symptoms associated with it distinguish it from menstrual headache. The symptoms of premenstrual syndrome (PMS) include headache with fatigue, joint pain, decreased urination, constipation, irritability or depression, mood change. After 4th to 12th day of menstruation, there is no symptom associated with premenstrual syndrome.
In addition to migraine or headache other symptoms reported by patients include vomiting, nausea, and photophobia.
- Ovarian hormones are thought to be behind the menstrual headache migraine and premenstrual syndrome (PMS) headaches.
Estradiol levels fall during ovulation and before menstruation and headache or migraine occurs during these periods give an indication that menstrual migraine significantly depends on estrogen levels.
- Estradiol was administered during this period and the result shows that the menstrual occurred at the expected time but headache delayed.
- If estradiol was introduced during follicular phase, migraine occurred.
- If progesterone was introduced, menstrual was delayed but migraine occurred at the expected time.
- At the time of menstruation, due to reduced level of estradiol and progesterone, prostaglandin secretion reaches maximum concentration, thereby increasing uterine contractions, causing dysmenorrhea.
- Women with dysmenorrhea, was found to contain increased concentration of prostaglandins in the endometriom and menstrual fluid.
- Plasma of prostaglandin was found to be at higher level during menstrual migraine.
- Prostaglandins induces nausea, diarrhea, flushing, cramping and inability to concentrate.
International headache society classifies headaches into three categories.
- Migraine without aura
- Migraine with aura
- Chronic tension-type headache
Migraine without Aura
- At least five of the attacks as mentioned below must occur for this type of migraine.
- Headache should last for 4 to 72 hours if untreated.
- Headache should include at least two characteristics from unilateral location, pulsating quality, moderate to severe intensity inhibits or prohibits daily routine activity, aggravated with routine activity.
- Headache should be accompanied by nausea or vomiting or light sensitivity or sound sensitivity.
Migraine with aura
- Migraine with at least two attacks having atleast 3 of the following mentioned characteristics is considered as migraine with aura.
- If one or more aura symptoms occurs and are fully reversible.
- If at least one aura symptom develops gradually over more than 4 minutes or if simultaneously 2 or more than 2 symptoms occur.
- If no single aura symptom continue for more than 60 minutes.
- If headache begins just before or within 60 minutes of an aura symptom.
Chronic tension-type headache
- If the average frequency of headache or migraine is 15 days per month for at least 6 months.
- If at least two of the pain characteristics, pressing or tightening, mild or moderate severity, bilateral location, no aggravation from physical activity, occurs.
- If headache is not accompanied with vomiting.
- If headache occurs with nausea, light sensitivity or sound sensitivity.
- Avoiding alcohol, cheese, and chocolate, late sleeping, as all these factors may aggravate the symptoms of headache.
- Physical fitness and exercise may help in reducing stress.
- Psychological stress should be identified, treated and monitored.
- Keeping a stable estrogen state will prevent menstrual migraine.
- Estrogen in gel form can be applied for stabilizing estogen level.
- Non-steroidal anti-inflammatory drugs (NSAIDs) can be used for prophylaxis of menstrual headache and analgesia. These drugs blocks prostaglandin synthesis, which may play a role for menstrual headache and dysmenorrhea.
- If particular NSAIDs is not affective, other class of NSAIDs should be tried.
- Women on beta blockers or calcium channel blocker may require increased dose of these medicines in specially premenstrual or vulnerable phase.
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