Expert Answer: How will infertility treatment affect my migraines?
Infertility medications, in general, work to trigger ovulation. Ovulation creates the development of an ovarian follicle (egg) that be fertilized and result in pregnancy. However, in working to trigger ovulation, infertility treatment can aggravate migraines. This is especially true for women who have a hormonal trigger to their migraines.
In a woman not on infertility treatment, the pituitary gland in her brain produces follicle stimulating hormone (FSH) and luteinizing hormone (LH). The FSH stimulates estrogen production from the ovary; LH stimulates progesterone production from the ovary. The amount of FSH and LH influences the rate of production of estrogen and progesterone in a normally functioning ovary.
Infertility medications work like FSH and LH to trigger ovulation. In the case of Clomid (Clomiphene citrate), a commonly used infertility medication, it increases the production of FSH and LH from the pituitary. Pergonal, another commonly used infertility medication, directly stimulates the ovaries and has FSH and LH in it. It is considered an hMG (human menopausal gonadotropin). Repronex is another example of an hMG. Clomid is an oral medication in contrast to the hMG medications which are injectable. Interestingly, hMG’s are made from the urine of post-menopausal women.
All infertility medications have the risk of increasing migraine. They also carry the risk of multiple pregnancies and a syndrome called ovulation hyperstimulation syndrome (OHSS). Clomid is considered to have less risk of OHSS than the gonadotropins.
I recently asked a migraine patient in my practice how her infertility treatments affected her migraines. She said the medications made her too sick to have sex and get pregnant!
For those of who facing infertility treatment, what can you do? I recommend you discuss with your treating headache provider and your infertility provider a preventive approach to your migraines during this vulnerable time. Non-pharmacologic treatment for prevention may include biofeedback; acupuncture; physical therapy; massage therapy and stress-reduction techniques. Taking Riboflavin (B2) and Magnesium (both 400 mg total daily dose on the average) may be helpful for prevention and in general, are considered safe for pregnancy. In some cases, taking a daily prescription preventive like a Beta-blocker (common ones include Propanolol and Labetalol) may be necessary for migraine prevention. Topamax, a commonly used migraine preventive, should be avoided as it has recently been linked to an increased risk of cleft palate and has been re-categorized by the FDA to Category D instead of its former Category C pregnancy risk.
In summary, infertility treatment would be expected to worsen migraine so my advice is to be prepared! I am interested in hearing how some of you were able to successfully navigate the world of infertility treatment while keeping your sanity and migraines under control.
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