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headache and Migraine treatment and pain treatment
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My wife has suffered migraines since giving birth to our first child. she now gets them monthly, usually coinciding with her period. she does not take any contraception pill. The headaches generally last 3 to 4 days and wear her out. They are of differing intensity and predominantly are on her right side. she also feels nauseous and lethargic. My wife is 36 and has been a vegetarian since she was 8 (no meat or fish) but eats dairy foods. Normal blood pressure, however often low in iron and B12. Any immediate advice on medication available or treatments (preventative) appreciated.
Regards
Stuart

REPLY:
Dear Stuart,

Hormonal/Menstrual Migraines are not unusual. It's also not unusual for childbirth to change the pattern of a woman's Migraines. HOWEVER, it is very important that any Migraineur who is experiencing a change in pattern discuss this with their physician to be sure there isn't a secondary condition present.

Hormonal/Menstrual Migraines can be some of the most difficult to prevent and treat. Although triptans are abortives rather than preventives, a couple of them -- Amerge and Frova -- HAVE been found to be helpful as preventives for menstrual Migraine. Usually, they're taken for six days, beginning two days before the woman's period. I have an article about Amerge for that use:

* Amerge To Prevent Menstrual Migraine
In a recent double-blind study, Amerge was found effective for preventing menstrually associated migraines and reducing the duration of break though migraines.
http://headaches.about.com/library/weekly/aa050101a.htm
I recently read a journal article about using Frova the same way, but haven't had a chance to write it up as an article yet.

I'd suggest that she discuss this possibility with your doctor. Something else that she may want to discuss is whether birth control pills or other hormone therapy would help. As with anything else, some people find that it helps, some find the opposite. An estrogen patch is often effective at a MUCH lower dose than oral estrogen, and some find Evening Primrose Oil capsules to be helpful instead of or in addition to estrogen.

As for general Migraine preventives, there are many, many medications and combinations of medications available for Migraine prevention. The medications include antihypertensives such as beta blockers, calcium channel blockers, and ACE inhibitors; tricyclic, SSRI, and other antidepressants, medications originally developed for seizure disorders; and others. Only with your wife's complete medical history and a full physical examination will a doctor be able to advise you which preventive medications would be most appropriate and potentially effective.

Thanks for being a caring spouse and good luck to you both,

Teri Robert
(answer reviewed by Dr. Krusz)

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