A new menstrual-related migraine routine for me
A few months back, I wrote a review of my migraine.com colleague Dr. Susan Hutchinson’s book The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to Find Hope and Wellness.. As can be expected, the parts of the book I found most useful were the ones in which Dr. Hutchison described migraine patterns that were similar to my own.
Because I am one of the many migraineurs who has another chronic illness (in my case, it’s psoriatic arthritis, an autoimmune condition), my medicine cabinet has a selection of prescription medications I can use to treat my issues. There are two kinds of triptans—sumatriptan (name brand Imitrex) and naratriptan (name brand Amerge)—for acute migraine attacks. I have cyclobenzaprine (name brand Flexeril), a muscle relaxer my rheumatologist has prescribed for me to take at night when my muscles and joints are aching. There’s also an anti-inflammatory drug I have for arthritis pain called Mobic (it hasn’t been that effective for me so I rarely use it). In addition to prescriptions, I also have some over-the-counter drugs in my repertoire: naproxen sodium (name brand Aleve) to take along with my triptan for acute migraine care, ibuprofen for muscle inflammation, and magnesium glycinate for regular migraine prevention, to name just a few. Add in a spray-on form of magnesium (reviewed here for migraine.com), some muscle rubs, and more, and you have my medicine cabinet pretty well summarized.
But back to Dr. Hutchinson’s book. The doctor makes it very clear that all medical protocols described in the book are for specific patients and that readers must talk to their healthcare providers in order to get their own treatment regimen. As an expert in the field of women with migraine disease, Dr. Hutchinson knows a lot about how a woman’s hormones affect her migraine patterns. She lists a few different approaches she takes with certain patients, outlining lifestyle changes, dietary recommendations, and medication regimens she prescribes. A few courses of treatment she has many patients pursue have the goal of combatting the awful bouts of migraine many women like me deal with every single time a period comes. “That time of the month” is generally not very pleasant for any ladies, but for women with migraine disease it can be a pretty rough ride.
One preventive routine sounded especially appealing to me because I already had the elements of it in my medicine cabinet. Now, for about the fifth month in a row, I’ve been following this regimen. Two days before my period is set to arrive (thankfully I have pretty regular periods so can tell when menstruation is on its way), I begin taking magnesium glycinate and a half-dose of cyclobenzaprine (muscle relaxer) each night an hour or two before bed. I take the combination all throughout my period (which can sometimes be interminably long—what luck!). It seems inevitable for me to get at least one, if not two, breakthrough migraines. When I do, I take a prescription naproxen sodium tablet (available over the counter as Aleve) along with the naratriptan (name brand Amerge). Dr. Hutchinson’s book helped me learn that naratriptan has a longer half-life than does my other triptan, Imitrex, meaning the pill’s effects last longer than Imitrex’s. This is great for those who deal with migraine attacks day after day during their periods, as the medication will last longer in the system so fewer pills will need to be taken to combat the migraines. My neurologist is the one who made me promise to take the Aleve with my triptan—she says the occurrence of rebound headaches is much lower if naproxen sodium/aleve is taken along with the triptan. In my experience, her assessment is dead on!
All this is to say my periods have been far less disruptive since I started this new routine. Instead of seeing my period as a week-long temporary death sentence, a time where I will have 5-7 days stolen by menstrual-related migraine, I now can cope with my period like a somewhat regular person. True, I still get mild migraines (usually one a few days before heavy flow starts and a second one on my first day of heavy flow), but they respond quickly to my naratriptan/naproxen sodium combo and I can go about my day.
The first few months this worked, I almost didn’t want to talk about it for fear of jinxing myself. But right now as I type, I am more than halfway through with my period and I’ve only had two days affected by migraine this whole week, and neither migraine attack was particularly bad. I feel so grateful!
Please remember that the intent of my blog on migraine.com is to share my personal stories with you and to encourage a safe space where we can talk about what it’s really like to live the life of a migraineur. If you want to work on improving your menstrual-related migraines, I highly suggest you borrow or buy (from an independent bookstore, of course) a copy of Dr. Hutchinson’s book and then share it with your doctor before making any changes to your routine. Let me know how you’re doing out there!
How much has your migraine disease changed or evolved over time?