I am 32. How to manage my severe migraine episodes?

Question

Hello doctor,

I am a 32-year-old woman experiencing severe migraines several times a month, usually around my period. The pain becomes so intense that I have to lie down in a dark room for hours. I have tried basic painkillers, but they barely help. My doctor mentioned preventive treatments and injections, but I am unsure which options are safest for women, especially those with hormonal triggers. I am also curious whether birth control can make migraines better or worse. Are there specific lifestyle changes, diet patterns, or stress-reduction techniques that genuinely help? I want to prevent these episodes so I can function normally at work and in my daily life.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Migraines that occur around menstruation are called menstrual migraines and are caused by a drop in estrogen levels. These attacks are often more intense and less responsive to regular painkillers. During an attack, triptans (such as Sumatriptan or Rizatriptan) work better than common painkillers when taken at the onset of headache. Combining them with NSAIDs (non-steroidal anti-inflammatory drugs) such as Naproxen may provide additional relief.

For frequent or severe attacks, daily preventive medicines such as Propranolol, Topiramate, or Amitriptyline may help. For hormone-linked migraines, short-term prevention with Naproxen or Frovatriptan for three to five days around menstruation can be effective. CGRP (calcitonin gene-related peptide) antibody injections, such as Erenumab, Fremanezumab, and Galcanezumab, are newer monthly preventive treatments that are safe for women and do not affect hormones. They are useful when oral preventives are not effective.

Combined pills (estrogen and progesterone) can worsen migraines in some women, especially in those who experience aura. In such situations, progestin-only pills or IUDs (intrauterine devices) are safer options. It is important to consult a gynecologist before starting hormonal contraception. Maintaining regular sleep, meals, and hydration, along with avoiding skipped meals, can help. Limiting caffeine, alcohol, and processed foods is beneficial. Identifying personal triggers such as chocolate, cheese, or stress is also important.

Relaxation techniques such as yoga, deep breathing, meditation, and regular light exercise can reduce migraine frequency. Keeping a migraine diary helps track triggers and patterns. With appropriate preventive treatment and hormonal management, menstrual migraines can be well controlled. Regular follow-up with a neurologist and a gynecologist supports both safety and effectiveness.

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

Thank you.