Migraines and PMS

No one knows exactly what causes migraine headaches, or even what happens in the body and brain when someone has one. One thing that is known, however, is that three times as many women as men have migraines. Many female migraineurs will also confess that their headaches are likely to coincide with the period just before their menstrual period.

A whopping sixty percent of women migraineurs have migraines during their period and during the rest of the month. Fourteen percent only have a migraine headache during their period. Look at the numbers; seventy-four percent of all women migraineurs associate their period with their headaches, and while medical science does not deny the connection, the reason for it is still unknown.

In addition, many women who become migraineurs later in life say that their pre-menstrual syndrome (PMS) symptoms became much more acute since the headaches began. A study published in the January 2006 issue of Headache confirmed the apocryphal evidence. Women participating reported that bloating, weight gain, breast tenderness, mood swings, back pain, and abdominal cramps all became more severe during a migraine.

The women in the study were given a medication to induce a temporary artificial menopause by halting the action of the ovaries. Even with the hormonal ups and downs of regular periods eliminated, they still reported worsened PMS symptoms during a migraine attack.

The fourteen percent of women who only have migraines during their period are said to have “menstrual migraines”. There is hope, though. For some lucky women, taking a brief course of NSAIDs (non-steroidal anti-inflammatory medicines, like ibuprofen) for several days prior to their period as well as the first few days of it can stave off a menstrual migraine. Women who want to try this type of prophylactic treatment should discuss the option with their doctor.

Migraines and Obesity

Are you more likely to have migraines if you are obese?

The simple answer, for adults, is no.

The more complicated answer is sort-of. Obesity does not cause migraines in adults—the jury is still out on how obesity affects pediatric migraine

That’s the good news. The bad news is that migraine and obesity can have a devastating affect on each other.

While obesity does not cause migraines, migraines, especially for people with migraines plus chronic daily headaches, can lead to obesity. People with migraines are likely to spend more time being sedentary, forced to inaction by the pain in their head. Additionally, many medications given to migraineurs cause weight gain directly, others cause it indirectly by increasing appetite.

Weight gain leads to depression in many people, which leads to more unhealthy behaviors (compulsiveness, hopelessness, increased inactivity, etc.) Inaction, weight gain, and increased appetite—a road that begins in migraine may well end in obesity.

Recent studies have divided migraineurs into different categories by their body mass index (BMI). The higher the body mass index, the more overweight the patient. The majority of the study participants were women, and median age was approximately 38 years.

Obese migraineurs, those with a BMI of 30 or higher, are far more likely to have extra problems with their migraines than people with a lower BMI are. Patients with higher body mass indexes reported more frequent headaches that lasted longer and were more severe than those experienced by lower BMI patients were.

There have been several studies on weight and headache prevalence, especially migraines, in children and teens. The initial results are a little frightening since almost all of them saw a correlation between a high BMI and incidence of migraines and other types of severe headaches (tension headaches, cluster headaches). All agreed, however, that more research is needed.

Migraines and Insomnia

A bout of insomnia will often bring on a migraine in someone prone to them. Having a migraine will often lead to insomnia. It sounds like a vicious cycle, and, for some migraineurs, it can be.

Insomnia is characterized by the inability to fall asleep, stay asleep, or fall back to sleep if awakened unexpectedly. Head and abdominal pain from a migraine may exacerbate the inability to sleep in people already inclined to sleep disorders.

A 2005 study published in Headache, the journal of the American Headache Society, discusses the links between poor sleep and migraines. Most of the study participants reported some form of sleep trouble and over 50% attributed migraine onset to sleep disturbances at least some of the time.

Almost 40% of participants admitted to sleeping six or less hours a night. These “short sleepers” experienced more frequent and severe migraines than other migraineurs. Short sleepers were also more likely to wake up with daily headaches, a condition known as transformed migraines.

Over 85% of the study participants said they chose to sleep or rest because of headache pain and 75% said the pain forced them to sleep.

Insomnia and migraines have something in common. Serotonin deficiency is linked to a number of disorders, including migraines and insomnia. Serotonin is a neurotransmitter thought to be an important part of the body’s regulation of sleep, mood, appetite, vomiting, and body temperature. It is manufactured in the gastrointestinal tract, where 90% of it is produced, and the central nervous system, and then stored in the blood.

Insufficient serotonin levels are also associated with several gastric disorders. This may explain why so many migraine sufferers experience stomach problems prior to or during a headache. Lack of serotonin is also likely to be a major component in the phenomenon known as abdominal migraines.

Migraines and Depression

Being in pain so fierce that the only recourse is to hide in a dark, quiet room until it is over several times a year would make anyone sad. Migraineurs, though, are five times more likely to develop clinical depression than people who do not have these debilitating headaches. Conversely, people who are depressed are three times likelier than happy people to become migraineurs.

Many scientists view the intertwining of migraine and depression as a chicken or egg situation. They are patently comorbid, but does one cause the other? If so, which one starts the process, the migraine or the depression? The answer is not that simple. Migraines, depression, and, unsurprisingly, insomnia, a state associated with both conditions have something in common. All three are associated with neurotransmitter deficiencies in the brain.

Doctors believe that while they are related, depression and migraine headaches have distinct causes with a similar neurobiology. For years, doctors blamed depression in migraineurs on their resultant loss of quality of life due to headaches. Now it looks as though the link is a biologic shared mechanism rather than psychology.

One danger for clinically depressed migraineurs is possible drug interaction between their depression medication and their migraine drugs. In July 2006 the FDA recognized one such danger, that of mixing triptans for migraines with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors), used to treat depression and mood disorders. Combining the drugs can lead to a condition called serotonin syndrome.

Serotonin syndrome occurs when there is too much serotonin in the body. Symptoms include hallucinations, increased heart rate and body temperature, fast changes in blood pressure, and gastrointestinal upset. Sometimes a patient has no choice but to take these medications together, but they need to weigh their options with their doctor and be monitored closely for serotonin syndrome.

Migraines and Caffeine

Migraineurs have a love-hate relationship with caffeine. For many, the vasoconstrictor helps alleviate their migraine pain. For an equal number, the chemical is a migraine headache trigger. The relationship between caffeine and migraines is anything but straightforward.

For caffeine addicts who discover that their daily cuppa is a migraine trigger the problem of caffeine is particularly thorny. People who regularly consume large quantities of caffeine often experience withdrawal headaches if they do not get their regular java jolt. If they are predisposed to migraines, the headache they get if they cut out the caffeine is going to be a doozy. Many people think caffeine withdrawal alone can bring on a migraine. Regular caffeine-aholics are advised to lower their caffeine intake slowly so they do not send their body into withdrawal.

Many migraine pain relievers include caffeine. The vasoconstrictive action of caffeine helps relieve migraine pain for some people. One current theory of what exactly goes on in the head during migraine proposes that arteries in the temple get inflamed during an attack and vasoconstriction would reduce the inflammation. Another possible reason to include caffeine in a migraine medication is because it acts as a supplement to the main analgesic. Studies have shown that many analgesics function more efficiently and pack a greater punch when paired with caffeine, though no one is sure exactly why.

Caffeine shows up in many unexpected places, so migraineurs who are sensitive to it (not all are) need to be vigilant label readers. Everyone knows about beverages, things like coffee and colas. Caffeine is also found in many clear or fruit-flavored sodas. Caffeine can be found in chocolate; the darker the chocolate the more caffeine it contains. Caffeine is in many over-the-counter analgesics, and not always clearly labeled. Migraineurs should be especially warty of caffeine in over-the-counter migraine formulas of regular medications.

Migraine Trigger Elimination Dieting

Science can’t explain why so many migraineurs claim that there is a link between certain foods or beverages and their headaches, but they do. Sadly, the food triggers are different for each migraine sufferer—it’s not like someone who needs to lower their cholesterol and the doctor tells them to eat egg whites and lose the bacon, migraineurs have to figure out their triggers on their own. The best way to do this is with an elimination diet.


The first step in any elimination diet is to put together a suspect list. A migraineur has had a headache the day after every football party for years. What is served? Who hosts? What items never change from party to party? If it doesn’t happen every time, what was different? Did someone else make the potato salad this week? List the suspects and move to step two.

This is the hardest step in an elimination diet. Until a suspect is identified, everything from the meal that seems to trigger a headache must be eliminated. Then the dieter can add items back into their life, one at a time, until they identify a trigger. Once the trigger is identified, it can be avoided.

Do not stop with the first trigger identified. Most migraineurs have multiple triggers. If an elimination diet is going to help someone, he or she needs to identify all the triggers.

For many migraineurs, the trigger is not a single food, but a combination of foods. For example, avocados trigger migraineur A and B is okay with them. However, when B eats guacamole he gets a headache every time. Why? Guacamole is made up several common triggers including avocado, citrus juice, seasonings, and vinegar. B may be okay consuming any one of these alone, but combine them and its sure formula for a headache.

Migraine Stages

Migraines develop in four stages. Patients with migraines with aura, also known as classic migraines, are most likely to experience all four stages. Patients who have common migraines, migraines without aura, will have the same stages, but are not consciously aware of them. The interval between migraines is sometimes referred to as the fifth stage of a migraine.

Stage One – Prodrome

The prodromal phase usually begins one or two days prior to the actual migraine headache. Many migraineurs call this the “premonition” phase. Feelings during this phase are all over the map. Each migraineur has their own personal prodrome profile. Some are giddy, happy, and full of energy, far more so than usual. Others feel a headache start with fatigue, weakness, and irritability. Anything can herald a migraine and each person has to learn their own prodrome signs if they want to learn to stave off the migraine.

Stage Two – Aura

This phase is skipped by most migraineurs, since most migraineurs suffer from common migraine, migraine without aura. For those who experience classic migraine with aura, auras can begin anywhere from five minutes to an hour before the headache begins. Auras are visual effects migraineurs experience. Objects appear to have bright auras or haloes around them. Lightning flashes arc over the field of vision until sight is whited out just before the pain begins.

Stage Three - Headache

This phase lasts anywhere from four to seventy-two hours. Most common is a one-sided headache with a throbbing or pulsing characteristic. The headache is frequently accompanied by stomach upset, nausea, vomiting, and sensitivity to light, sound, smell, or some combination of the three.

Stage Four – Postdrome

Coming away from a migraine can be as unpleasant as building up to one. Postdrome is often characterized by tenderness of the head, neck, and stomach. Weakness and fatigue are also common in this phase.

Migraine Prodromes

A migraine prodrome is a premonition or advance warning that a migraine is coming on. Prodromes can occur anywhere from a few minutes before the onset of a headache to days prior. While no one knows the specific cause of migraine prodromes, the prevailing theory is that they are part of neurochemical change in the brain that occurs before an attack. Approximately 60% of all migraineurs (people who have chronic migraines) experience some type of prodrome.

Migraine Auras

Migraine auras are a specific type of visual prodrome in which people see things that are not there, like flashes of light or haloes around object. This type of prodrome is rare and experienced by less than 25% of all migraineurs.

Emotional Changes

Many migraine sufferers describe mood alterations preceding an attack. Some people are euphoric, others fall into a profound despondence, and still others experience uncharacteristic irritability or impatience.

Metabolic Changes

Some migraineurs describe their prodrome experience as an enormous spike in energy levels during the day preceding the headache itself. Others say that they know a migraine is coming because they get fatigued or listless or find themselves constantly yawning prior to onset.

Appetite Changes

Some migraine sufferers lose their appetite before a headache. Some sufferers find themselves ravenous the day or night before an attack. Still others have noticed that specific cravings tend to precede their migraine.

Sleep Changes

Insomnia is a frequent prodrome symptom for many migraineurs, as is difficulty falling asleep. Others experience lassitude and difficulty waking prior to a migraine.

Migraines are often difficult to diagnose and treat because no two migraine patients experience the same prodromes, if they experience one at all. Many migraineurs experience all of the prodrome symptoms at different times before a single headache, or different ones prior to different attacks.

Migraine Myths

There are a number of commonly held beliefs about migraines that make it hard for sufferers to get proper diagnosis and treatment.

1) Migraines are not real (all in the head, an overreaction to a normal headache, etc.).

Not true. Migraines are a biologic primary headache disorder. Even migraine pain is not confined to the head, though that is generally where it is worst.

2) Migraines have a known cause.

Sadly, no. There have been several interesting theories put forward in the last decade, but no single, definitive biological cause of migraines has been identified thus far.

3) All migraineurs have the same symptoms.

No, they don’t. This is one of the things that makes migraines so hard to diagnose, particularly if a patient’s doctor is only familiar with the most common symptoms.

4) A doctor can tell if it’s a migraine or not.

Not always. The wide spectrum of symptoms that can accompany migraine can make it difficult to diagnose, more so if the patient is not forthcoming with their doctor about all their symptoms.

5) Migraines are curable.

Again, no. Once properly diagosed many migraineurs still have to devote a lot of time and energy to managing their condition through medications, natural and homeopathic remedies, and diet and lifestyle changes. The various available coping methods work differently for each individual, so there is not even a single protocol of care.

6) Migraines are a woman’s headache.

Women migraineurs do outnumber the men 3 to 1, but there is no evidence the condition is sex-linked in any way.

7) Only adults get migraines.

Migraines have been diagnosed in adolescents, children, and even infants.

8) Every headache a migraineur is a migraine