Expert Review: Bloodletting, leeches, and hysterectomy
The history of migraine treatments reads like a chapter out of a bad thriller. Treatments of old included drilling holes in the skull, bloodletting, and the use of leeches.
Interestingly, some of these treatments are still in use today. If you search for medical studies published in scientific journals within the last few years, you'll find articles describing bloodletting techniques for migraine, still used in Asia and other parts of the world.
Hysterectomy is another migraine treatment that I'd thought was put away on some dusty shelf. The link between menstrual periods and migraines has long been recognized by both patients and their doctors. After women go through menopause, migraines often improve, leading doctors to speculate that hysterectomy might be an effective migraine treatment intervention, particularly in women with menstrual migraines who had completed their families. Research has generally shown that migraines do improve in postmenopausal women -- at least among women who enter menopause naturally. (Migraines often worsen temporarily when menopause first starts and women experience symptoms like hot flashes. Migraine improvement is expected during the later stages of natural menopause.)
Women undergoing surgical menopause after hysterectomy and ovary removal are more likely to experience migraine aggravation than relief. The most often reported study looking at the impact of menopause and migraine was published by researchers in Italy in 1993. In this study, migraines improved for two in three women after natural menopause. Migraine worsened for two in three women after surgical menopause (hysterectomy with removal of the ovaries).
The journal Acta Obstetricia et Gynecologica Scandinavica will be bringing the question of hysterectomy as a migraine therapy back to the forefront later this year with an article supporting hysterectomy and removing ovaries to manage migraines. In this study, a 40-year-old woman had been through a lot of migraine treatments and hormonal therapies for her menstrual migraines. Eventually, her doctors gave her the medication Lupron to cause a medically-induced menopause. After playing around with additional hormone therapy, her migraines improved and she continued Lupron for 14 months. At that point, she underwent hysterectomy and removal of her ovaries, becoming headache free. The authors of the study concluded that hysterectomy and ovary removal might be considered as a treatment for menstrual migraine.
The important take home messages from this new study and previously published studies are:
- Hysterectomy is probably not an effective migraine treatment for most women with migraine
- In some cases, women whose migraine improve with medical menopause may continue to do well after hysterectomy
- While the woman in the case described in Acta Obstetricia et Gynecologica Scandinavica did well after hysterectomy, there may have been numerous other factors that affected her migraines that were not taken into account, especially as her migraines had been fairly well controlled for almost a year before surgery
- This report will probably result in newer large studies evaluating how migraines have changed in large groups of women entering menopause, comparing natural and surgical menopause. These types of studies will help confirm whether some women might consider hysterectomy or not
The study should not make hysterectomy routine practice as a treatment for menstrual migraine. But this positive report may help doctors select which patients might be analyzed in future studies to help answer this question.
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