Please note: This transcript was created by robots, and has not been edited for accuracy by a sentient being.

00:01:08

Today we are going to dig into deciphering the mysteries of perimenopausal health. I'm Bree Luck, and we're going to look at a topic today that's a really common concern among many of our listeners, and it actually comes today from a question. Here's the listener question. "Dear Bree, I am a 51-year-old woman experiencing perimenopause. yuck. And I'm having frequent migraines.

00:01:35

Why are they happening so often, and how can I manage them?" from "A real headache" in Washington, DC. First of all, thank you. A real headache. Migraines are no small matter, and they can be super, super challenging during hormonal transitions like perimenopause. You are not alone.

00:01:56

And today we are going to do a deep dive into this topic. And the topic is all about migraines. So migraines are actually a super common issue among individuals with Ovaries, particularly during the hormonal ups and downs of perimenopause. Now, let's remember, I'm going to say this several times in this episode, everyone's hormonal journey is unique. Everybody's body is unique.

00:02:22

And as we discuss the studies that we're going to cover today, I want you to take them as general information, not as personal advice. Also, remember, I'm just like a girl with a microphone and a computer. I'm not a medical professional. So if you come across conflicting information, share it with me. I'm only as good as what I'm reading.

00:02:44

And in today's exploration of migraines, I'm looking primarily at two studies. But before I even get into the studies, I want to get into, what the heck is a migraine? The Mayo Clinic describes migraines as a severe headache, often characterized by intense throbbing or pulsing on one side of the head. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. A migraine can last from a couple of hours to a couple of days, and it generally has to be severe enough to disrupt your routine to be considered a migraine.

00:03:27

Some people, not all, but some people who have migraines also experience an aura that's some kind of a visual disturbance or a tingling sensation prior to or during the headache portion of the migraine. So the first study that we're looking at is called evaluation and Management of Migraine in Midlife Women by J. M. Pavlovic. It was published in 2018 in Menopause the Journal.

00:04:01

Don't worry about noting it down. I will definitely link the study in the show. Notes so what we know is this migraines are more common in individuals with Ovaries and they tend to peak in their late 30s. So that's early, like the very onset of perimenopause. It's a chronic condition that results in moderate to severe pain related symptoms and significant disability.

00:04:34

So menopausal transition or perimenopause can amplify these migraines. Migraines often worsen during the menopause transition but do improve after menopause. So there's hope. Migraines triggered by menstruation can intensify during perimenopause but typically stabilize post menopause. And so that's good to know, right?

00:05:00

So if you have migraines that come on as part of your menstrual cycle, that may intensify during perimenopause but usually resolves or stabilizes after menopause. However, there is one big caveat here, and that is that surgical menopause or traumatic menopause can increase the frequency or the intensity of migraines. I don't know for how long, I don't know any more about that. I haven't been able to find a good source of information on that. If you find one, let me know.

00:05:37

So triggers for migraines can differ from person to person, but for many menstruation is a common culprit. So research suggests that a quicker drop in estrogen levels may be intrinsic to individuals with migraines. Migraines related to menstruation come in three different types. There's a pure menstrual migraine PMM, which only occurs paramestrally, menstrual related migraine MRM, which can occur paramestrally and at other times and nonmenstrual migraine, which is unrelated to menstruation. So diagnosing these migraines may be hard and I'm thinking particularly of the reader question.

00:06:24

I don't know which kind of migraine you have. You may not know either. Something that you may want to do before you go speak to your medical practitioner is to keep a journal. So try having a headache diary. Regular tracking can help with effective diagnosis and treatment of migraines.

00:06:43

Because of the mostly predictable nature of paramestrual attacks, short term treatments during these risky days can be used. And this is called miniprophylaxis. So treatments are tailored to individual factors such as headache characteristics, menstrual cycle relationship, menopause stage comorbidities, current medications, and of course, personal preferences. And typically an integrated approach is suggested and that could include hormone treatment, preventative and acute headache medications, and nonpharmalogical treatments like lifestyle changes and therapy. And we'll talk about some of those later.

00:07:28

I'm going to talk a little bit about some of the acute medical treatments. So acute treatments typically include non steroidal, antiinflammatory drugs, NSAIDs, and if needed, tryptans so for medical migraines with regular cycles, miniprophylaxis using those NSAIDs or tryptans a few days before mensis can be effective. Another thing that some people use is transdermal estradiol. And that seems to be pretty effective in reducing migraine occurrence. So that is one of the many prophylactic uses.

00:08:09

Okay, so for pre menopausal and postmenopausal women, preventative medications are frequently used. These include beta blockers, topyramate tricyclic, antidepressants, and other second line agents. However, drugs that constrict blood vessels like tryptans should be avoided in postmenopausal women who have cardiovascular risk factors. In perimenopausal women, exogenous estrogen has been used to even out fluctuating estrogen levels as a way to treat migraines. So there are lots of different types of estrogen, but right now, I'm going to talk about two different types.

00:08:50

There's an endogenous, which is what's made by your body, and exogenous, and that's estrogen that you're adding from the environment. There are exogenous sources of estrogen in food. There are exogenous sources of estrogen in medication. Sometimes that's called hormone therapy. You may hear it called several things.

00:09:14

It can be called hormone therapy. It can be called menopausal hormone therapy. It can be called hormone replacement therapy, HRT, it's called all different things. Hormone therapy is not contraindicated in women with migraines, but should be used cautiously in those who have migraines with an aura. So remember that's when you get the visual, some kind of a visual symptom or a tingling symptom before the onset of the migraine.

00:09:46

All right, now that was the first study. Now let's look at a more recent study, and I don't know if it will really clarify anything or not. I found it interesting, and I feel like what we're really getting to is a place where we're starting to figure out what some of the specific factors are that could be causing the headaches. So in this more recent study published on February 22, 2023 so quite recent, this was in the online issue of the Medical Journal of the American Academy of Neurology. And this study looked at the role of something called calcitonin gene related peptide CGRP.

00:10:38

And that's a protein that is believed to trigger migraines. And they looked at that and the impact of estrogen level changes on those CGRP levels and migraines. Okay, so we're getting right down to the protein that seems to trigger migraines and looking at it in conjunction with estrogen. So this study looked at three groups of individuals with ovaries those with regular menstrual cycles, those on oral contraceptives, and those who are postmenopause. Each group was compared to a similar group of participants who didn't experience migraines, and they looked at blood and tear fluid samples to measure those CGRP levels.

00:11:28

I'm just thinking about how much I cry these days. I love that they use tier samples, because I just want you to know, if anybody needs tear samples, I have copious amounts of tears. I mean, I I can't watch television without crying. I can't watch it queer Eye. Queer Eye one of the happiest shows on television.

00:11:53

I cry. I cry in Queer Eye. I'm blaming it on the hormones. That's all I have to say. Okay, so they used these tear samples to measure those CGRP levels.

00:12:04

They had some intriguing findings. So people with a regular menstrual cycle who experienced migraines indeed had higher CGRP concentrations during menstruation compared to those without migraines. However, this pattern was absent in participants on oral contraceptives or who were postmenopause. Generally, individuals with migraines had higher CGRP levels in both blood and tear fluid compared to those without migraines. Okay, so what does this mean?

00:12:44

Well, this suggests that hormonal fluctuations, especially those related to estrogen levels, could trigger migraines during menstruation and perimenopause. However, it's super important to remember that these findings are preliminary. We know this study just came out in February, and the study's author highlighted the need for more extensive studies to confirm the results and to understand this complex relationship. Yes, to more studies. Now, let's switch gears for a minute and talk about some actionable steps for managing these perimenopausal migraines.

00:13:23

Let's remember, these are general suggestions made by your friend. Lifestyle changes can be significant. It's true. They don't tend to happen immediately. But over time and with consistency, lifestyle changes can really help with migraines.

00:13:42

So what does that mean? It means maintaining a regular sleep schedule. I don't say that lightly. I know how hard it is. It makes me as mad as it makes you if you also have insomnia.

00:13:54

But we know that quality rest can make a difference. So anything that you can do to prioritize sleep is going to help. Also, get some regular exercise that you enjoy that can reduce stress. It can potentially mitigate migraines. It doesn't have to be running 5 miles.

00:14:13

You can do a Zumba class. You can walk around your neighborhood. You can dance in your kitchen. It doesn't matter. Just exercise.

00:14:21

Just move your body. Okay, another one. Diet. There are so many things that can trigger migraines in people. I mean, we know red wine for some people, caffeine for some people.

00:14:36

We know sugar. We know gluten for some people. There are so many things. It's going to be different for a lot of people. Keeping a food diary can help to identify potential triggers.

00:14:47

So keep that diary. You can keep that diary to see when your migraines are happening and what you're eating around that time. All right? You'll also want to keep yourself well hydrated, but I don't want you to just go down like, a two liter bottle of water in one sitting. That would be a very brie move to do, by the way.

00:15:08

I tend to be all or nothing, but that's not what you want to do, because you'll just eliminate it immediately. It's not going to do you any good. It may make you sick, actually, that water poisoning thing. So sip it throughout the day. Get a water bottle that you like.

00:15:25

Splurge on the water bottle that you like. If you have a hard time drinking water, some people use apps. I don't use apps. It's one more thing to do. But I do have a bottle that I really like, and I try to fill it twice a day because it's a big bottle and it's yellow and it makes me happy.

00:15:39

All right, so that's one thing. Getting rid of dehydration. I'm going to talk a little bit about medical treatments, but we've already covered them. Some hormone therapy could be an option. And then, of course, there were the range of preventative and pain relieving medications.

00:15:55

You're going to want to talk to your healthcare provider to really look at the right fit for your specific needs. All right? Natural treatments. See, if you're like me, you're like, I don't want to go to the doctor. I just want to go to my health food store.

00:16:09

I hear you, I hear you. And I'll be really honest. When we're looking at herbal supplements, it's really hard to tell. There is so much contradictory evidence. First of all, there aren't a whole lot of studies on herbal supplements because they don't make the moolah that the pharmacological industry wants to invest in.

00:16:33

So they don't make the money that medical interventions make, right? So they don't get as many studies. There are studies I'm not going to over generalize that. I want to thank the scientists who are studying all the things, not just the things that they're being paid by big pharma to study.

00:16:55

But I was just talking to Jeff the other day about placebo effects, and my feeling is, if it's not going to hurt you, that's a big if. If it's not gonna hurt you and the placebo is useful, then the placebo effect is useful anyway. I'm also not trying to say that all of the natural treatments are placebo effects. I don't think they are. I just don't know, and I just want to be clear about that.

00:17:22

So herbal supplements, vitamins, minerals can be useful adjuncts in managing migraines. Some of the commonly used supplements include fever, few, and black cohosh. And the one I use a lot is turmeric, turmeric with black pepper. However, it's vital to consult with your healthcare professional before starting any new supplements in case there are any contraindications, especially if you're on other medication. All right.

00:17:52

There are also alternative therapies, like my personal favorite, acupuncture, my other personal favorite massage, and also something that I really like are essential oils. And they can all provide some relief for some individuals. I will say, though, that there is also some indication that essential oils can disrupt our hormones. So I would say to maybe keep a journal around that and see if they seem to be related for you. Maybe they'll help, maybe they'll hurt.

00:18:23

Hard to know. But, you know, these noninvasive approaches can promote relaxation and can help manage stress, which can be beneficial for migraine management. We have covered so much ground today looking at the link between migraines and hormonal fluctuations during perimenopause. It is an area of ongoing research, and new insights continue to emerge. If you are experiencing migraines, my friend, my friend, remember that support is available.

00:18:54

That wraps up today's episode. I hope this information has shed light on the complex relationship between migraines and perimenopause. As always, I am here to answer your questions, to talk to experts, and to explore the topics around midlife that matter to you. If you have any questions or topics that you'd like me to explore, let me know. Visit my website@posdigopodcast.com and leave me a message.

00:19:21

Or you can join the Facebook group. I'm going to put a link to that in the show notes as well. It's a private Facebook group. You can ask me questions, and I can answer them on the podcast. All right, thank you for tuning in and being a part of the Pause to Go community.

00:19:38

Remember to stay curious, y'all. Thank you for listening to the Pause to Go podcast. Special thanks to Codebase Coworking and WTJU Radio for their support. This has been an awkward Sage production.