Expert Answer: Hysterectomy and migraines

Last updated: October 2022

Women often ask me if a hysterectomy will cure them of their disabling menstrual migraines. They are often at a point of incredible frustration willing to risk a major surgery if it would stop the horrible severe monthly hormonal headache that robs them of quality time with their family, causes missed days of work, and brings pain and suffering.

The problem is that if women are thrown into menopause by a complete hysterectomy (uterus and both ovaries are removed), then studies indicate that 2/3 of them will have worsening of their migraines and only 1/3 will improve. The problem is the dramatic drop in hormones from having the ovaries removed. This throwing a woman into menopause can hurt, rather than help, her migraines.

So, what do I recommend for women desperate to have a hysterectomy and for whom all hormonal treatments such as continuous low-dose birth control pills have failed? I would recommend “medical menopause” with add-back estrogen. Specifically, I would recommend an injection of Depo-Lupron which shuts the ovaries down to mimic a surgical menopause but then use add-back estrogen such as with an estradiol patch (name brand Vivelle dot) to simulate if a hysterectomy could be helpful. The injection lasts for 1-3 months depending on which one used and is reversible unlike surgery. The add-back estrogen is to prevent the dramatic drop in estrogen which can aggravate migraines. In addition, the add-back estrogen can prevent hot flashes, night sweats, insomnia, and osteoporosis.

I have had several women improve dramatically with Depo-Lupron; several went on to have a complete hysterectomy and were given add-back estrogen immediately after surgery. In these women, the “trial run” with the Depo-Lupron gave us the confidence that surgery made sense. So, for a small subset of women migraine sufferers, a complete hysterectomy may be helpful, but a “trial run” with inducing medical menopause with Depo-Lupron is recommended. Additionally, for some women I see, we can use continuous low-dose birth control pills or the continuous vaginal contraceptive ring, and avoid surgery. Traditional preventives such as Topamax, Inderal, Elavil and Botox may be helpful also in reducing the burden of migraine and may prevent a hysterectomy. My recommendation is to explore other options first before having a complete hysterectomy.

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