Sandra Greenbank shares with us how you can support patients suffering from menstrual migraines.
Menstrual migraines are migraines that occur a couple of days leading up to a period, and in the first few days of a period. It is thought to affect up to 10% of women, and 70% of female migraine sufferers report a worsening of migraines just before or during their period. These migraines can be debilitating and interfere with day-to-day life.
Common migraine symptoms include:
- Throbbing pain
- Often one side of the head
- Sound, light or smell sensitivity
The most prevalent theory is that menstrual migraines are triggered by a rapid drop in oestrogen towards the end of the menstrual cycle (1). This withdrawal of hormones acts as a trigger in women with menstrual migraines. Wild fluctuations in oestrogen combined with low progesterone during peri-menopause are also associated with migraines that may seem erratic but have the same root cause.
The conventional treatment is to suppress the hormonal cycle by using different forms of hormonal contraception, as they all stop ovulation and therefore the rise and fall of oestrogen and progesterone. However, this is often not effective. The combined hormonal birth control also carries a higher risk of stroke for migraine-sufferers with aura than for other women (2) and headaches are a known side effect of both the combined contraceptive pill and the progesterone-only pill.
Start with the gut
Addressing oestrogen metabolism and clearance may help address menstrual migraines naturally without the need for painkillers or hormonal treatment. As poor gut health can reduce the excretion of oestrogen from the body (3) it’s a good idea to start here. When the gut is healthy and the diet contains adequate amounts of fibre, oestrogen binds to fibre in the digestive tract and is thereby excreted.
Cruciferous vegetables are known to help support liver detox of oestrogens, and broccoli sprouts are especially high in sulforaphane, which have a unique ability to stimulate phase 2 liver detoxification of oestrogen (4).
Foods that stimulate bile production also help increase the excretion and prevent a build-up of cholesterol-based hormones such as oestrogen. Bitter vegetables such as rocket and chicory are examples of bile stimulating foods. In addition, hydration helps keep the bowels moving, while reducing alcohol and caffeine may also help to optimise oestrogen detox pathways.
Xenoestrogens are chemical endocrine disruptors that can act as oestrogens once inside the body. Xenoestrogens can be found in our makeup, lotions, cleaning products, plastic packaging, pesticide residue and food preservatives to name a few. One of the ways to reduce exposure to exogenous oestrogen is to eliminate exposure to these products as much as possible.
Magnesium and B vitamins
Magnesium supplementation of 260mg/day started on 15th day of cycle until the 1st day of flow, has been shown to be an effective treatment for menstrual migraines, and it is possible that a lower migraine threshold could be related to magnesium deficiency (5). 50% of migraine sufferers have been found to be deficient in magnesium and some researchers suggest all migraine sufferers should be treated with magnesium (6) and this is supported by other studies, too (7).
Vitamin B2 at a dosage of 200mg twice a day has been shown to reduce the frequency of migraines by 50% (8). Vitamins B6, B9 and B12 have also been shown to be effective in alleviating migraines (9). Since the B vitamins work in synergy with each other as well as magnesium, it may be preferable to use a B complex alongside a magnesium supplement.
Studies show that menstrual migraines are associated with an increase in pro inflammatory prostaglandin levels in the endometrium during menstruation, indicating a role for Vitamin E (10), since vitamin E inhibits the release of arachidonic acid and the conversion of arachidoic acid to prostaglandins (11). One study reported a reduction in pain severity, light sensitivity and nausea among female migraine patients who used vitamin E 400 IU/day for two days before and 3 days after menstruation (12).
An anti-inflammatory diet consisting of omega 3 fats and plenty of vegetables may help address excess inflammation alongside a Vitamin E supplement.
Other dietary strategies
Wheat is a common migraine trigger, and one study showed that eliminating wheat resolved migraines in 89% of patients (13), although not specific to menstrual migraines it is worth a trial of a gluten free diet.
Aged cheese, red wine, chocolate, gluten, food additives and preserved foods are common triggers for migraines, and incidentally these foods are also high in histamine.
Histamine problems may be at play, due to elevated oestrogen stimulating mast cell release of histamine (14) and histamine, in turn, stimulates the ovaries to make more oestrogen (15). This creates a vicious circle of increased histamine and oestrogen in circulation. Strategies to address histamine excess include:
- Reducing high histamine foods in the diet.
- Supporting oestrogen clearance pathways (as before)
- Investigate intestinal dysbiosis, as some gut bacteria are histamine-producing
- Support diamine oxidase (DAO) to increase histamine clearance
- Supplement Vitamin B6 (a DAO cofactor) (16)
Nutritional therapy can be an incredibly powerful tool to address the root cause of menstrual migraines, without the need for prescription medication.
You can find out more about Sandra here: www.sandragreenbank.com