I am 35, female. Are my migraines due to hormonal changes?

Question

Hello doctor,

I am a 35-year-old woman who has been getting severe headaches about two to three times a month for the past year. The pain is usually on one side of my head and feels like throbbing or pulsing. When these headaches occur, I become very sensitive to light and sound, and sometimes I feel nauseous or vomit.

I have noticed that the headaches often happen around my menstrual cycle or when I am stressed at work. Before the headache starts, I sometimes see flashing lights or zigzag patterns in my vision for about twenty minutes. Regular over-the-counter pain relievers do not help much, and the headaches can last anywhere from four hours to two days, completely disrupting my life. Could these be migraines, and is there a connection between my hormones, stress levels, and these disabling headaches? What steps should I take to manage this?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From what you have mentioned, these recurring headaches that feel like throbbing occur on one side, worsen with light and sound, and are sometimes preceded by visual changes like flashing lights (aura), strongly suggest migraine with aura. The nausea, vomiting, and the way these headaches affect your daily life are also common signs of migraines.

You mentioned that these headaches often happen around your menstrual cycle and during times of stress. That is very important. Hormonal changes, especially the drop in estrogen around menstruation, are known to trigger menstrual migraines. Stress, poor sleep, missing meals, and certain foods (like aged cheese or caffeine) can also increase the number or severity of these headaches.

Since you have a history of asthma, you should be careful with some pain relievers like non-steroidal anti-inflammatory drugs (NSAIDS) (for example, Ibuprofen), as they can sometimes cause breathing problems in sensitive people. Also, because of your history of irritable bowel syndrome, medicines that slow down the gut (like some anti-migraine medicines) should be used with caution. Probable diagnosis would be menstrual migraine with aura.

I would suggest the following tests :

Magnetic resonance imaging (MRI) of the brain (if there are any warning signs or unusual symptoms).
Hormone level tests (if the headaches follow your menstrual cycle).

Other conditions that may need to be ruled out include:

Migraine with aura.
Tension-type headache.
Hormonal headache.
Cluster headache.

The treatment plan includes using Triptans for immediate relief of headaches. For prevention, Beta blockers or anti-epileptic medications may be recommended if the headaches occur frequently. Hormone treatment can be considered if the headaches are linked to the menstrual cycle. Making lifestyle changes and avoiding known triggers is also important. Additionally, individuals with asthma should avoid non-steroidal anti-inflammatory drugs if they are sensitive to them.

Prevention tips:

Maintain a routine, including sleep.
Manage stress effectively.
Stay away from known triggers.
Keep a diary to track migraine patterns and triggers.

Consult a doctor after two to three weeks of starting the treatment, or sooner if the headaches get worse or new symptoms appear.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.