STORY BYIn one corner of the ring, we have 27-year-old medical resident Samantha Adkins. In the other corner, we have the undisputed champ of pounding pain—menstrual migraines.
“If I get a (menstrual) migraine, I’m down for the count,” she says.
For consecutive rounds, menstrual migraines—severe headaches that occur during a woman’s period—were successfully landing a barrage of punches on this second year obstetrics/gynecology resident at The University of Texas Medical School at Houston.
The day before or on the first day of her menstrual cycle, Adkins experienced one-sided throbbing head pain, in combination with sensitivity to light and nausea. “I just couldn’t do anything I would normally do.”
About 13 million American women are affected by migraines, and up to 60 percent of women associate migraines with menstruation, according to the National Headache Foundation.
Symptoms can include throbbing, pounding headaches, nausea and vomiting and sensitivity to light or sound. Only recently did Adkins regain control of her life. To manage the debilitating symptoms, she uses continuous oral contraceptives for menstrual suppression. Adkins hasn’t had a period for several months.
The idea of menstrual suppression is not new, but the re-packaged version of menstrual suppression called Seasonale is relatively new. The oral contraceptive was approved by the U.S. Food and Drug Administration in September 2003.
Seasonale contains the same hormones as traditional oral contraceptive pills, with a combination of estrogen and progestin. The Seasonale dosing regimen involves taking the active drug for 12 weeks or 84 consecutive days followed by a placebo or inactive pill for seven consecutive days. The "placebo" phase is designed to allow menstruation to occur.
Adkins hasn’t had a period in six months because she has opted not to take the placebo pills. “It’s not difficult or unusual for women to manipulate their cycles with the pill,” says Adkins’ treating physician Karen Schneider, M.D., a professor of obstetrics and gynecology at UT Medical School at Houston.
Experts say skipping a period for several months is safe because the hormones in oral contraceptives regulate the thickness of the uterine lining, preventing a buildup which causes the menstrual cycle.
“Some women think it’s unnatural not to have a cycle each month, but if you’re taking the pill to manipulate it, that’s fine,” Schneider says.
Schneider advises that women who aren’t on birth control and aren’t having regular monthly cycles should consult their doctor.
According to Pamela Berens, M.D., a professor of obstetrics and gynecology also at the Medical School, the exact causes of menstrual migraines are uncertain, but migraines have been related to the changes in the levels of estrogen, the female hormone. Estrogen levels drop immediately before the start of menstrual flow.
For many of Berens’ patients, fewer periods mean fewer menstrual migraines.
Breakthrough bleeding is the one disadvantage of using Seasonale: spontaneous spotting that occurs outside the time frame of the woman’s normal menstrual cycle. Adkins experiences “unscheduled” bleeding, but she says it’s not bothersome.
Another option for women suffering from menstrual migraines is a class of drugs called triptans. Triptans are not pain relievers in the traditional sense. They affect the changing levels of serotonin in the brain which may play a role in blood vessel dilation—one link in the chain reaction that causes migraines. Triptans abort a migraine-in-the-making.
Recently, tennis star Serena Williams spoke out about the pain she experienced with menstrual migraines and the relief she has received from taking Frovatriptan or Frova, a member of the triptan class of drugs. She takes one tablet up to three times a day when a migraine begins.
Later in life, irregular estrogen levels can also trigger another type of headache, a menopausal migraine. Usually by age 51, the ovaries run out of eggs and stop making estrogen. The loss of estrogen causes the typical symptoms of menopause such as hot flashes, night sweats and sleeplessness. The estrogen loss also triggers the migraines.
Four years ago, Maureen Wittels, 54, reached menopause which ended her periods but started her life-interrupting migraines.
To stabilize her estrogen levels, she was taking post-menopausal estrogen supplements, then an estrogen patch, but neither helped to prevent the headaches. “Twice the migraines were so severe I had to go to the hospital,” says Wittels.
Then Wittels began taking Zolmitriptan or Zomig (a triptan-class drug) to relieve migraine attacks as they occurred. “When I take the medication, I can function very nicely,” she says. “It’s wonderful relief.”
Wittels, almost on the other side of menopause, says her headaches happen less frequently. “Now if I get a migraine, it seems to be weather related.”
Even though migraine pain medication wasn’t the best treatment for her, Adkins says, “You have to decide what works for you.”
In the final round, Adkins KO’d her menstrual migraines.
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Dr. Karen Schneider is a professor of obstetrics and gynecology at UT Medical School.
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Dr. Pamela Berens is an associate professor in the Department of Obstetrics and Gynecology at the UT Medical School.
See Dr. Berens also at:
Eating healthy
reverses metabolic syndrome
Dr. Tasnime Akbaraly of University College London and her colleagues were interested if healthy eating could actually turn-the-tide and reverse metabolic syndrome, which is having 3 or more of the following risk factors: excess abdominal fat; high triglycerides, hypertension, low levels of HDL the “good” cholesterol, or type 2 diabetes. Having metabolic syndrome doubles a persons’ risk of heart disease and greatly increases the odds of developing type 2 diabetes.
The researchers studied 339 British civil servants with metabolic syndrome, and how closely the adhered to the Alternative Healthy Eating Index (AHEI) to see if it could help reverse metabolic syndrome. The AHEI is a set of published nutritional guidelines by the Harvard School of Public Health in 2002 that emphasizes whole grains, fruits, vegetables and decreased red meat consumption.
Five years into the study, nearly 50% no longer had metabolic syndrome. People who followed the AHEI guidelines the closest were nearly twice as likely to have reversed their metabolic syndrome. The results of the study were published in Diabetes Care, online July 29, 2010.
Dr. Alice Lichtenstein, an expert on diet and heart health from Tufts University in Boston who was not involved in the study said, "It's not about focusing on individual components of the diet, it's really the whole package, and that becomes important because it means that if one of the components of a healthy diet is to eat more fruits and vegetables, just buying a pill saying that there's a concentrated extract of fruits and vegetables is probably not what's going to help you."
Call and make an appointment with Wellness Coach Sam Hester, CWC, CPT, LWMC, at 713-500-3327. It's confidential and free. For more information on the wellness services provided, visit UT Counseling and WorkLife Services.
