Headaches in Women that present as Menstrual Migraines

Migraine is a very common problem amongst women. In fact research shows that the headache ratio for females/males is a staggering 4:11. When looking at potential reasons for why headaches are so much more common in women it is interesting to note that of women suffering migraine, the majority of sufferers are post puberty and within their reproductive life1. Headache prevalence is then shown to decrease post-menopause. So it is logical to infer that the constantly fluctuating sex hormones during the female cycle may contribute to the increase in headaches, especially during the menstrual period. Interestingly, a number of my patients have said that being pregnant gave them some of the best relief from migraines that they had ever experienced. One of the explanations for this change is thought to be the increased levels of oestrogen in the first trimester which then stabilises for the second and third trimester1. A study by Serva et al. compared the prevalence of migraine with and without aura during pregnancy and found that those who suffered migraine without aura had a 78% reduction in migraines by the third trimester. It seems women with migraines related to their menstrual cycle are much more sensitive to the fluctuations in oestrogen and progesterone than women who do not suffer from this type of headache, or any headache for that matter. The lead up to menses sees a drop in oestrogen which tends to precipitate the menstrual migraine. So what if we could somehow change the effects that hormones have on those who suffer from headaches? Clearly there has to be something that can be done because not every woman suffers from these headaches. Research into the functional neuroanatomy of neck pain by Goadsby and Bartsch has helped us understand and prove the relationship between the neck and headache presentation. It has been shown that the spread and referral of pain can be induced by the stimulation of structures in the upper neck and perceived as frontal lobe pain, i.e. headaches over the top front of the head. It is suggested that the brainstem, which receives various inputs from the brain and neck, is over-sensitised when a person has problems within the neck. This sensitisation of the brainstem caused by neck dysfunction then causes an exaggerated response to a usually normal amount of sensory input that wouldn’t ordinarily produce pain. In essence, input into the brainstem is put under a magnifying glass and blown out of proportion. An example of this phenomenon is found in women during their menstrual cycle. A hormonal change which would not usually produce headaches becomes magnified by neck dysfunction and leads to menstrual migraine. So what does this mean for getting rid of your headaches? Well, it strongly supports examining the neck as a possible contributor to your headaches. If examination by a skilled physiotherapist shows that your neck is at least a partial cause of your headaches then resolving your neck dysfunction will aid in reducing menstrual headaches. Whether the neck dysfunction was caused by poor posture, trauma, genetics or whether it is lying dormant and seemingly asymptomatic (aside from giving you horrible headaches!), fixing it is the first step to helping you live a headache free lifestyle. Blair Chapman MPT, BHK Completed Level 2 Dean Watson Headache Course Physiotherapist Precision Physio, Surry Hills Blair Chapman is a physiotherapist with special interest, training & expertise in the diagnosis & management of headaches & migraines. You can ask Blair a question about how physiotherapy may help your headaches by emailing him on [REMOVED] or calling (02) 9280 2322.