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Menopause - What a Headache!

Podcast Episode 20 transcript.

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Today, I'm talking about migraines in menopause.

Fact! Female hormones and migraines are linked. This is one of the reasons why women are three times more likely to get headaches than men.

A drop in oestrogen is usually the trigger, which is why women who struggle with migraines are often affected before their periods. During pregnancy, the body has a constant high flow of oestrogen, giving affected women a break, but migraines start again after a baby is born.

During perimenopause, as hormones swing up and down, some women might experience migraine for the first time. In contrast, others find that their symptoms are getting worse, with attacks happening more frequently and sometimes lasting longer. Migraines seem to mirror hormone fluctuations. 

In postmenopause, when hormones fluctuate less often, most women find their migraines will also happen less frequently. In general, it might take around three years after menopause for migraine to settle down.

However, non-hormonal triggers will still cause migraines, so it is important to look at the overall situation holistically.

If you have struggled with migraines for some time, you might know what your usual migraine triggers are and how to manage them.

If you are new to migraines, - never assume they are related to menopause - speak to your doctor, get familiar with common migraine triggers, and keep a diary.

For migraine sufferers, using HRT during perimenopause menopause can make things worse, so healthy women without migraine auras are better off stopping oestrogens from swinging up and down - for example, using combined hormonal contraceptives until they are 50, instead of using HRT that elevates their oestrogens levels. Progesterone-only contraception is recommended for women who get migraine auras.

It sounds a bit mystical, but Auras is a term used to describe visual disturbances that are usually experienced before migraine head pain starts and typically last for less than an hour.

If you struggle with migraines and are thinking about starting HRT, it's good to know that some preparations, especially tablets, can create hormonal fluctuations, which can trigger migraines. This tends to happen less with skin preparations, like gels and patches. Skin preparations are also safe for women who have migraine auras.

For women who have a hysterectomy, studies have shown that their migraines get worse. This is because, technically, the body is abruptly induced into menopause, sending the body into overdrive trying to compensate. This usually settles over a couple of years. HRT helps, especially if the ovaries have been removed as part of the surgery. However, hormones are thrown out of balance even if the ovaries are retained, so additional oestrogen still benefits any woman who has a hysterectomy. 

Women considering HRT who have a womb need progesterone as well as oestrogen. For progesterone, you might want to consider a hormonal coil, as this can also be used for contraception or to control heavy or painful periods, which is great for women whose migraines are triggered by heavy periods. Because it's local to the womb, very few hormones reach the blood, so the side effects are usually very few.

With vaginal oestrogens, which are used for vaginal dryness and as prophylaxis for water infections, some oestrogen will get to the bloodstream and might trigger an initial increase in migraines till blood levels eventually settle down. This might take a while, but it will eventually settle for most women with regular use.

Suppose you are struggling with migraines, together with hot flushes & night sweats, and you would rather avoid HRT. In that case, you might want to have a discussion with your doctor regarding using low-dose antidepressants, which have been found to help in these situations.

I think we can all appreciate how personal and specific treatment needs to be for every woman going through menopause. There is no one-size-fits-all fix here, so I encourage you to speak with your doctor. Most NHS practices will have a doctor or a healthcare practitioner specialising in menopause; if not, they can refer you to a local NHS menopause clinic. We must remember that although frustrating, some medications might not work for you or need adjusting at any point after starting. This is very natural, as everybody reacts differently to treatments, so it is important to check in with your doctor if things are not quite right. Do not struggle in silence, but at the same time, your doctor cannot know that something is wrong unless you speak to them. If this cannot happen quickly enough, email your practice or fill out a contact form on their website.

Apart from medications, There are ways to minimise headaches and migraines:

Avoid missing or delaying meals, as dropped sugar levels in the blood can trigger migraines. Eating fibre and a balanced diet rich in vegetables can also prevent blood glucose levels from swinging up and down, which can also trigger migraines.

Learning to recognise the patterns and triggers of your migraines is key. Keep a journal to track when headaches occur and what you do, eat, or feel beforehand. This can provide valuable insights into your personal headache triggers.

Prioritise sleep, maintain a regular exercise routine, and consider relaxation techniques like meditation or yoga. These practices not only support your overall well-being during menopause but can also help manage migraine frequency and intensity.


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