Causes, treatment and prevention of headache during the menstruation, before and after them

Headache (more GB, cephalalgia) is a common problem among people of working age, especially among women. The ratio of the frequency of occurrence of GB among men and women is on average 1:2, given the diversity of forms and causes of cephalalgias. Many women with early menstrual cycle headache becomes either preceding or accompanying symptom. Next, you will learn why women have GB during menstruation and how to deal with it.

Causes of seizures

The First attacks of pain may begin in the period between ten and thirty years. Headache associated with menstruation, usually intense and long-lasting. Among the main causes of cephalgia, associated with menstruation, can be called migraine and tension headaches (hereafter TTH). On the background of fluctuations of level of hormones (namely progesterone, estrogen and prostaglandins) have a change of excitability of neurons and the extension of brain vessels.

Menstrual migraine refers to a form of the disease occurring without aura, however experts do not deny the possibility of the appearance of the aura (see table below).

	Subspecies	Criteria	Reasons	Time occurrence	Frequency of occurrence
Migraine (primary headache)	Migraine without aura (the primary United migraine associated with menstruation)	True menstrual migraine	Triggered by a sharp fall in the level of progesterone and estrogen. Increasing levels of prostaglandins	Mainly in the first two or three days (or a little sooner or later)	Observed in 7-19% of women
		Menstrual-associated Naya migraine			is Observed in 60% of women

Criteria of menstrual migraine are listed in the table below (in G. R. Tabeeva).

Tension Headaches (TTH) arising on the background of low mood, crying-easily thing, depression during the premenstrual period of clear criteria, but also distinguished by the clinical presentation.

Menstrual migraine cannot be fully diagnosed by doctors-gynaecologists, neurologists and General practitioners due to the fact that women do not seek help, thinking that the headache before menstruation – one of the premenstrual syndromes. The task of the neurologist is the purpose of the treatment and preventive measures, taking into account individual characteristics.

Alarms

In the presence of GB must immediately consult a doctor. A woman at any age should be wary if she noticed any of the following signs (according to V. V. Osipova).

A Woman needs to remember that headaches that often concerned, reduce the life of the organism.

clinical Features and symptomatology of migraine

Why are women more prone to migraine? Menstruation is considered to be one of the most common triggers, because pain can occur in early puberty and continue until menopause. This usually occurs in the first 48 hours after you started your period, either earlier or later.

Migraine with menstruation has feature "rolled" attacks, pain localized on one side. Most often pain when the migraine is concentrated in the temples, eyes, or frontal portion. May be accompanied by nausea, vomiting, photophobia and phonophobia. The reason for the increase in pain can be a physical activity (climbing stairs).

A Typical feature during the menstrual migraines is the long duration and pain intensity. The first day of menstruation resulting in the highest intensity. However, women say that menopause or pregnancy the frequency of headaches decreases.

Diagnostic signs of the disease

The Criteria by which is diagnosed migraine, are divided into two types: menstrual-associated migraines and true. Both have common features, which are characteristic of migraine without aura:

1. the Attack can last up to three days if treatment is not applied.
2. Headache is characterized by at least two of the following symptoms:

• focuses on one of the parties;
• throbbing, pain intensity average or above average;
• activity causes increased pain.

3. Accompanying symptoms (at least one of these):

• nausea, possible vomiting;
• painful irritability on exposure to light or noise.

4. the Symptomsare not related to any other disease.

The Following are the criteria differentiating migraine:

• associated with the period – time of occurrence of migraines have menstrual-associated – in the first 48 hours of menstruation in at least two of the three periods of the menstrual cycle;
• true menstrual migraine are the same symptoms of seizures, but occur only in two of the three monthly periods.

Migraines, which is associated with the beginning of menstruation, difficult to treat. In addition to the duration and severity, the complexity due to the individual properties and response of the body.

for TTH sensations usually have a dull, oppressive in nature, are localized on both sides (like "Hoop"), the power of pain is moderate or average, the most affected temporal, frontal and parietal region. Perhaps light nausea, vomiting if these cephalalgias are not typical, but physical activity does not cause amplification of pain.

the Algorithm for the diagnosis of the patient

due to time constraints in the outpatient appointment, the patient can be asked questions to find out why the pain and how to deal with them:

1. do you See the occurrence of headaches during the period of the menstrual cycle, namely two days before the beginning of menstruation and three days after the beginning of the month?
2. for each whether you celebrate menstruation pain syndrome?
3. between periods do you suffer from headaches?
4. have you Noticed an increased intolerance (increased pain), nervousness, is caused by light or other stimuli for headaches associated with the menstrual cycle?
5. have you ever Noticed that a headache before my period is stronger than is usually the case?
6. are You unhappy with your sleep?
7. if you React badly to the change of weather?
8. was it a stroke? Do these surveys?
9. does a headache on your daily activities?

In the case of a positive answer to the first and some of the two other issues may be suspected menstrual migraine.

Table-questionnaire about the patient's condition during the headaches associated with the critical days

Intensity of migraine	Frequency of symptoms	The degree of influence of headache on the overall status
42% - moderate pain	Photophobia – 42%	no Impact – 58%
	Phonophobia – 60%	a Light – 58%
58% - severe pain	Nausea – 50%	Hard state – 58%
	Vomiting – 8%	Bed rest – 58%

To effectively diagnose menstrual migraines should keep a special diary. The patient must note down the attacks of GB on the first day of the menstrual cycle, when they are observed for all critical days, to make it possible to establish a link and to facilitate treatment.

Main areas and methods of treatment

Treatment of menstrual headaches is usually divided into drug and non-drug therapy, which contribute to the mild asthma.

1. Drug therapy: drug groups, names, trade names and patterns of use.

The Purpose of treatment with medicines is related to the degree of pain in migraine. NSAIDs allowed to apply, if the pain is mild or moderate. These include non-steroidal anti-means (applied to the inside, can be in the form of suppositories): "tylenol, Ibuprofen, Ketorolac, Naproxen or Aspirin", as well as drugs, containing codeine "Solpadein", "Spasmodically".

Before using drugs, it is important to know about possible consequences. So, for example, frequent use of painkillers can cause abussou headache, i.e. Pain caused by back-effect of medication. Also, the use of substances containing codeine dangerous addictive. The risk is increased in case of headache in women are very frequent (more than ten outbreaks per month).

If worried about nausea or vomiting, are assigned to the use of antiemetic drugs:

• Domperidone. Trade names: "Gallium", "Motilium", "Motilal", "Domstal". The application scheme: inside at least twenty minutes before a meal. The recommended dose is 10 milligrams three or four times a day, the dose may be increased to 20 milligrams, with a pronounced vomiting and nausea.
• Metoclopramide. Trade names: "Climatol", "Perinorm", "Reglan". Scheme of use: inside, in special cases – intravenously or intramuscularly. Daily dose three times to 10 milligrams before a meal. For intramuscular or intravenous use one ampoule three times a day.

If there is high intensity of headache and the duration more than three days, he is assigned to a specific therapy. To substances able to act on the pain half an hour after application, include selective agonists, ortriptana:

• Sumatriptan. Trade names: "Amigrenin", "Arpimed", "Sumamigren", "Trimaran". The application scheme: inside 50-100 milligrams. The daily rate should not exceed 300 milligrams.
• Relpax (Eletriptan). The application scheme: inside. For adults the recommended dose of forty grams. When repeated attacks through the day the drug is taken again in the same dosage. Under the following attacks, the dose can be doubled. The daily rate shall not exceed 160 milligrams.

The peculiarity of the impact of these drugs is that they affect the receptors located in the CNS and in the periphery. Their action helps to narrow blood vessels that have expanded during migraine attack, does not allow the selection of protein molecules that cause pain, thereby completing the headache.

Effective result in the use of the above substances can be achieved as early as possible in their application about an hour after started the headaches. Earlier than administer the drug, the greater the probability of termination of the migraine attack, reduce its duration and prevent recurrence of headaches.

2. Therapy, do not involve the use of therapeutic drugs.

Under non-pharmacological therapy refers to the treatment of migraine, in which not used the drug. These methods of treatment include psychotherapy, including:

• cognitive-behavioral therapy (is to change the direction of thoughts of the patient that cause the disorder);
• relaxation technique (the method in reducing anxious feelings during the menstrual cycles, learn why they arise);
• feedback (this method helps to change the body's reaction to certain processes).

Also, the method of correction of risk factors, which controls the time of sleep, sets the diet, increased stress, helping to prevent migraines. Apart from the above mentioned treatments, can be used some methods of physical therapy: massage, acupuncture, medical gymnastics.

3. Compliance with measures for preventing seizures can reduce the likelihood of headaches associated with menstruation.

The Main goals of preventive treatment:

• a decrease in the intensity of headache, duration and frequency;
• obstacle to the use of therapeutic substances, addictive effect;
• blocking effect of migraine attacks on the vitality
• improve the life of the patient.

Prevention of the appearance of attacks

To prevent or to prevent headaches caused by the menstrual cycle, the necessary number of measures, compliance with which may reduce the risk of migraine.

1. medication

Prophylactic treatment is necessary if pain bothered too often. Given oral drugs such as isoptin, propanolol or amitriptyline. Also, in addition to the traditional prevention, the recommended drugs of magnesium.

requires a prescription from your doctor evening primrose oil. A woman needs to take it twice a day, the dose is half a gram.

2. Therapy-related changes in hormonal levels broken

The Increased hormonal levels that occur on the fifteenth day after the beginning of critical days, it becomes a cause of migraine. Doctors may prescribe hormone therapy, the essence of which is to replace the missing female hormones such as estrogen and progesterone. Apart from its effects, this therapy is beneficial effect on the genitourinary system, prevents the onset of menopause and cardiovascular diseases.

3. Migraine and combined oral contraceptives

Hormone therapy oral contraceptives (COCS) also applies to preventive measures. However, its effect is contradictory. Before using this method of prevention and treatment be sure to consult with your doctor to avoid problems. Women who have resorted to the use of oral contraceptives should stop Smoking.

Migraine, which is accompanied by focal symptoms, is often a contraindication to the use of COCS (particularly involving 7-day break), in this case, you want to choose another method of contraception.

Complex measures of prevention and treatment make life easier for patients suffering from headaches during menstruation. Timely access to a neurologist can help to take this pathology under control. Do not tighten with treatment, do the prevention, don't be afraid to refer to specialists – and then the disease will not bother you.

Sources:

1. V. V. Osipova, G. R. Tabeeva Primary headaches. A practical guide. M.: OOO "PAGE-Print", 2007. 60s.
2. G. R. Tabeeva, Yu. e. Azimova. Migraine in women. Medical scientific-practical journal “the doctor”
3. M. A. Wayne, E. G. Filatova Treatment of headache. Medical scientific-practical journal “the doctor”
4. Tabeeva G. R. Menstrual migraine. Independent publication for practitioners