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Hormonal Headaches

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. I have horrible migraines every month, a few days before my period and/or as it ends. This has been going on for about 10 years and I am 49 years old. The rest of the month, I am fine and feel wonderful but I dread that week where I know I will have a headache almost every day. I take Imitrex, which usually takes the headache away, but makes me feel jumpy inside. My ob/gyn hasn't been much help.

A. Women are likely to suffer from migraine three times more often than men. These are often triggered by fluctuation of estrogen levels, and as you have discovered, may be worse just prior to or during menstrual periods or during the perimenopausal period. Other substances often trigger migraines as well. If these can be controlled, you may notice a marked decrease in both the number and intensity of headaches. Frequently noted triggers include the phenols in red wine and alcoholic beverages, many aged cheeses, cured or smoked meats, sour cream, or beans. Monosodium glutamate (MSG) can also trigger severe headaches, so avoid it altogether. Some experts feel that a diet that has plenty of fresh fruits and vegetables in the most natural state is going to create the best plan for relieving or avoiding headaches. The more preservatives a food contains, the more likely it is to trigger a headache.

Sometimes, the absence of food brings on a headache. Skipping meals is one of the worst things you can do if you are prone to headaches. This can start a hypoglycemic reaction that causes stress, tension, and fatigue, and you can therefore not only have a migraine headache but a tension headache as well.

Limit (but don't completely eliminate) your caffeine intake to 200 milligrams per day. (An eight-ounce cup of coffee contains between 60 and 130 milligrams of caffeine; tea has 30 to 50 milligrams per cup). Caffeine is also present in cola drinks and chocolate. Drink decaffeinated soda, coffee, herbal tea, or buy a coffee substitute made of chicory.

Imitrex works by constricting all of your blood vessels and should be used cautiously by someone your age, as you are at risk to have other medical conditions such as hypertension. An alternative may be a low dose of an antidepressant; some of these have been found to be helpful for PMS by boosting serotonin, and hormonal headaches may be helped via the same mechanism.

Prevention is very important. A very regular diet as well as aerobic exercise is beneficial for headaches of all types. Some herbs may also be helpful. Mild migraines may be helped by the herb feverfew, a type of daisy. Feverfew works like aspirin to inhibit prostaglandin, preventing the blood vessel spasms that trigger migraines. Vitamin E (400 IU) and vitamin B are also helpful for migraine prevention.

For more information, you can call the National Headache Foundation at 888-NHF-5552 or visit its Web site:

National Headache Foundation

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