Headaches & Migraines

Migraines

Migraines are a neurogenic condition – meaning they are caused by, controlled by, or arise in the nervous system – that is associated with changes in brain perfusion. Perfusion is the process where blood flows through microscopic blood vessels in order to exchange oxygen, carbon dioxide and other molecules through your cell walls.

Research suggests that the early phase of migraines comes from inflammation in the nervous system that affects the blood vessels in your brain and your dura, which is the membrane that surrounds the brain and the spinal cord (your central nervous system).

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Migraines are a primary headache disorder that can cause severe or even crippling pain and other symptoms. Intense, throbbing headaches that last from hours to days are only one symptom of migraines. [9] Some people experience recurrent migraines, and when these happen they are called migraine episodes or attacks.

There are four stages to the classic migraine, although not all individuals will experience all four stages, and even the same individual may not experience all of the stages all of the time.

1. The prodrome stage marks the beginning of a migraine episode. In some cases, avoiding triggers (such as alcohol or certain foods) may prevent the migraine from progressing any further. Keeping a food and drink diary can be helpful to see patterns in your daily life that may be the trigger for your migraines.
2. The aura phase usually comes immediately before the headache starts. It is characterized by visual disturbances such as seeing flashes of light or having blind spots in one or both eyes.
3. In the headache stage, the pain is typically extreme and can be on one or both sides of the head.
4. The final stage is called the postdrome stage and it has been called the ‘migraine hangover’. The length of the postdrome stage varies and not every migraine is followed by a postdrome.

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Fluctuations in estrogen are linked to migraine headaches. You may get migraines for the first time or see an increase in severity or frequency during perimenopause. Some women have the reverse reaction, and see a reduction in migraine occurrence as they enter the menopausal transition. This may be because high levels of estrogen can trigger headaches and diminishing levels can cause a decrease. [10]

If you suffer from regular migraines, you may be prescribed medication for their treatment. Be aware of medication-overuse headaches – headaches that occur as a result of the medication used to treat headaches. These can occur as part of a vicious cycle where you get a headache, treat it with medication, and the medication gives you a headache.

Guidelines for healthcare providers recommend treating headaches no more than 10 days per month with prescription medications and no more than 15 per month with acetaminophen or ibuprofen. Acetaminophen, sold under the brand name Tylenol, is a fever reducer (antipyretic) and pain reliever (analgesic). Acetaminophen can also be found in some prescription medicines – be careful not to use the over-the-counter form at the same time as prescription medications containing acetaminophen as there is an overdose risk. Ibuprofen, sold under the brand names Advil or Motrin, is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation and pain. [11]

Tension Headaches

These primary headaches are the most common type of headache and are usually experienced as dull aching pain in your head. The pain often feels like a tight band around your head. While the underlying causes are not fully understood, they occur when the muscles in your neck and scalp are tense and contract, usually in response to stress, depression, or anxiety. The menopausal transition is associated with an increase in depression and anxiety, and also with increased muscle tension, so if you are experiencing more tension headaches than in the past they could be a result of those perimenopause symptoms. [12]

Tension headaches can be episodic or chronic. Episodic tension headaches last from 30 minutes up to a week. If you experience continuous headaches or if your tension headaches occur 15 or more days of the month for more than three months, then they would be classified as chronic headaches. [13]

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Cluster Headaches

These extremely painful headaches typically occur in cycles called cluster periods that can last from weeks to months. The cluster periods are followed by periods of remission that last from months to years, where there are no headaches. These headaches usually come with no advance warning although it is possible to experience nausea or auras (temporary visual or auditory disturbances, for example where you see light in random patterns). The pain usually occurs in, behind, or around one eye, and it may radiate to other parts of your face, head, or neck.

Cluster headaches appear to originate in the hypothalamus area of the brain although what triggers them is currently unknown. The trigeminal nerve, which is located near your eye and branches up to your forehead, above your ear, across your cheek, and down your jaw, carries the pain signal from the hypothalamus. Cluster headaches appear to be linked to your circadian rhythm as they often happen at the same time every day and are even nicknamed the ‘alarm clock’ headache. [13] [14]

Cluster headaches are relatively rare and are statistically more common in men. However, because of the link to your circadian rhythm, menopausal transition symptoms that impact your sleep could be associated with the experience of these debilitating headaches.

Sinus Headaches

Sinuses are air-filled chambers inside your skull, found in your forehead, behind your cheekbones and behind the bridge of your nose. The main function of your sinuses is to make mucus that moisturizes the inside of your nose and protects the air passage from outside pollutants (such as dust, dirt, and micro-organisms) that get drawn into your system when you breathe through your nose.

When you have an infection or an allergic reaction, your sinuses make more mucus. When this mucus doesn’t drain properly, the pressure inside your sinuses builds up and causes a sinus headache. The pain feels like a deep constant pain and will get stronger if you move your head, especially if you bend over.

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Menopausal transition symptoms don’t directly affect your sinuses, however, increased sensitivity to allergens could impact you and cause an increase in sinus headaches. General inflammation is associated with a decrease in estrogen, and this inflammation can slow down mucus drainage, causing these types of headaches.

Chronic Daily Headaches

This type of secondary headache occurs when a person has at least 15 days per month with a headache. The type of headache experienced in chronic daily headaches can vary, but the most common types are cluster headaches, tension headaches, or migraines.

Chronic daily tension headaches are typically mild and manageable.

Another common but manageable type of chronic daily headache is called medication overuse headache. These are often connected to the pain-relief medications taken for migraines. Guidelines for healthcare providers recommend treating headaches no more than 10 days per month with prescription medications and no more than 15 per month with acetaminophen or ibuprofen.

Transformed migraines are a common and debilitating type of chronic daily headache. These typically occur when migraines start becoming more frequent until there is no clear end or beginning to the severe headache. Ultimately there is a 24-hour continuous headache in the background with occasional very severe migraine headache pain. Unfortunately, this type of chronic daily headache is very difficult to treat, as it doesn’t respond to medications well. One hypothesis proposes that chronic migraine headaches actually scar brain tissue or cause other permanent changes to the brain, leading to the difficulty in treatment. Typically, these cases are managed with a variety of treatments to reduce the disabling pain. [8]