Expert Answer: Hysterectomy and migraines

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (9)
  • Vonnie69
    6 years ago

    I read this post with interest as my (long suffering) doctor recently suggested this as an ‘experimental’ treatment for my migraines. They started about 4 years ago and, as with most other migraneurs, I have tried numerous medications that have failed to help (apart from triptans, which occasionally work thankfully!) so I agreed to try this and had the Goserelin injection 6 days ago. I have some add back Tibolone for the second month, assuming the migraines don’t worsen and I opt for the second injection in a few weeks time. I have always been convinced that my migraines are hormone related, although not exclusively as I get headaches near daily and 10-15 migraines a month. They’re not all clustered around my cycle so they’re not what I would consider menstrual migraines. I try to remain optimistic every time I embark on a new treatment even though I invariably end up disappointed and feeling no better – here’s hoping this will help!

  • Dr Hutchinson author
    6 years ago

    The experiences all of you have shared points to the importance, I think, of not rushing into a complete or even a partial hysterectomy. I think even a partial hysterectomy can disrupt hormonal function and as Ellen as stated, even a minute change that may not be measurable by hormone blood tests, can aggravate migraine. Another factor is the disruption of the surgery itself in aggravating migraine control as any change to our bodies can be a trigger.

  • Saundra
    6 years ago

    I needed a partial hysterectomy at 30 for other medical reasons. While my migraines weren’t menstrual related (in fact they can’t find any physical ‘reason’) They have gotten drastically worse since the hysterectomy, though blood tests show my hormone levels are fine.

  • Saundra
    6 years ago

    Ellen- how would you know if it was a trigger if it was a minute change?

  • Ellen Schnakenberg
    6 years ago

    tonynzacksmom – Migraines can be triggered by hormonal upsets, even within the scope of *normal* ranges. Sometimes it is simply the change of levels that is the trigger. Even minute changes can trigger Migraine in many people.

  • caryd26
    6 years ago

    People (?) suggest to me that I get a hysterectomy because my migraines have always been hormonal and now that I’m in peri-menopause and have crazy fluctuations, my migraines have become chronic. I also keep meeting women in their 50s and 60s who say that their migraines all but stopped after menopause which leads one to believe that going into menopause and getting over it will help me greatly. I have tried the patch, but I am very concerned about breast cancer because my mother died of breast cancer at 53 (right when she was in menopause and one year after diagnosis) and her cancer was hormone receptor positive. So… I am still talking to my hormone specialist about all of this and it’s an on-going discussion. Meanwhile, the migraines continue.

  • mrsbrimtown
    6 years ago

    I may need a partial hysterectomy for a different medical issue, but I don’t get menstrual migraines. Usually I have a couple migraines each week w/ sometimes up to three weeks without any.

    Are there any indications on how a partial hysterectomy may affect non menstrual migraines?

  • Ellen Schnakenberg
    6 years ago

    I agree with you Dr Hutchinson – In my case we used Zoladex (goserelin) so I knew what to expect, which was not good. My Migraines got much worse, and when I had to discontinue add back hormones, I got a whole passle of other problems. I didn’t have my hysterectomy for my Migraines however, and although I would not recommend this as a Migraine treatment, I do encourage patients to have very honest conversations with their doctors if you need the surgery for other reasons as I did. The trial really was very helpful in preparing me before the final surgery.

    Remember – you are the one that has to live with the results, not your doctors or other family members. You cannot put organs back that have been removed, so just be absolutely sure you are making the right decision for you.

  • emc121264
    6 years ago

    I can attest to the fact that having a hysterectomy will not cure migraines. I had a total hysterectomy 11/30/2012, and have continued to have migraines, pretty severe at first (every day), but it has tapered off a little. I did not have the hysterectomy to rid myself of my migraines, it was medically necessary, but I did have hopes that it would help.

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