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Sunday, April 16, 2017

Gynecologist Guiede To Migraines

Your gyno is often the first to hear about your headaches and perhaps is going to be the one to diagnose you as having migraines instead of a headache.Your contraception, your nutrition, your supplements, your pregnancy treatment regimen, and even your cosmetic regimen might benefit from adjustment when you suffer from migraine headaches. So if you haven't thought to discuss this with your gyno, here are some things we consider at Women's Health Practice when you have migraines and your wellness regimens need to be adjusted. This post gives you ten very important considerations when treating your migraines

1.Diagnosis: 

If you have headaches, even if you have had them for awhile and have successfully self treated, come in to discuss what your symptoms are and why you may need a more specific diagnosis. This is always the first pathway to cure. Migraine sufferers do have headaches, but often they will have warning symptoms 'AURAS' as well. Some of the warning symptoms are vague and some are more typically recognized as migraines. These may be nausea, light adversity, odd sense of smell or even vomiting. These non-headache neurological symptoms that occur when the pain starts are known as auras. Gyneos are in touch with listening to you and helping to sort out when these symptoms may be related to hormonal changes or instead a symptom of migraine. Recent studies have shown that it is actually more common to have migraines without warning than with warning auras. But other women might have migraine symptoms that precede the actual headache pain by a day or even several days. And these symptoms may be those that are commonly recognized to be associated with migraines: like spots before your eyes, vision changes or, fatigue. Gynos classification of headaches is likely to follow the international classification from the IHS.

2. Cycle:

Be a tracker, if you are a woman between 15 and 55 you probably need to track your cycles. This has never been easier through apps, but even greater, it's never been easier to actually attach symptoms, like headaches, to the days of your cycle. 

Migraines that only occur with the menstrual period cyclic are called menstrual migraines. The risk of stroke in young women is low,and with or without migraines still low, but migraines with aura might be one of the more significant predictor of stroke, and might double one's risk. And if you have migraine, with auras, and take oral contraceptive pills gynos have said that your risk of stroke doubles,  the risk may double again if you have aura. However, hormonal based headaches can be managed by adjusting the hormone levels during the days of the cycle.   Menstrual migraines, can be just such an issue, since they are so hormone sensitive, perhaps they could be cured by the right pill. 

The hormonal reasons for menstrual migraines has focused as much as on the effects of estrogen hormone on headache as on the effects of the rapid lowering of blood estrogen levels in the days leading to the menstrual period. Estrogen levels build in the second week, peak around the ovulation, and then do drop off very rapidly just before the menstrual cycle. From cycle to cycle you may vary, and this may be a reason to carefully track your levels with proper estrogen testing. A a more rapid decline in estrogen in the late luteal  (second)of the menstrual cycle may predispose you to having migraines, and normalizing this can perhaps contribute to better control. Although all women have this estrogen decline, it may be the women who get migraines get more rapid decline than other women, producing the menstrual migraine trigger. Actually some of the hormonal fluctuations around ovulation can be as dramatic as the hormone fluctuations around the menstrual period and these fluctuations of the estrogen level can cause hormonal migraines as well. And up to 25% of women have menstrual migraines at least at some time in their lives!

3. Contraception:

The CDC publishes something every gynecologist reads: Medical Eligibility Criteria for contraception. Be mindful of the fact that your contraceptive choice will be influenced, but not prohibited by being a migraine sufferer. Hormonal contraception in the form of estrogen (so present in birth control pills, rings, patches) are prohibited if you have migraines with aura no matter what your age is. Although you can choose these methods when you are young and have migraines without aura, you may want to consider safer alternative contraception. Once you reach age 35 women without auras it is considered that you are in the most high risk categories. It mandates a yearly discussion and there are different guidelines for initiation verses continuing contraception. But the general recommendation: if you have migraines with aura, and are over the age of 35 then find another birth control method and get off your BC pills. We suggest thinking of non-medicated IUD. you have you can use POPs (progesterone only pills or the "mini" pill). You can probably safely use DMPA (depoProvera), INexplanon, and the Mirena IUD. So there are lots of good ways to contracept and get cycle control even if you have migraines. There are special types of migraines that may mean more work up, and may mean stroke risks, for that you do still have to have that discussion with your gyno before settling on the type of contraception. But don't give up on the idea of effective contraception just because a headache has you down! Correct contraceptive prescription can control cramps, help us normalize our weight, help keep us fertile, and you want your gyno to take all of these things into consideration, not just your headaches!

 4. Nutrition:

Nutritional management is critical to migraine management. This is pointed out by the American Nutritional Society. The levels of inflammation, the levels of nutrients, the presence of gut health will all affect whether you have migraines.. At various times of your life you will need changes to your nutrition. You need different vitamin levels if you are planning a pregnancy, starting hormonal medications, have PCOS, or  have become prediabetic. All of these nutrient levels can affect headache frequency and intensity. More normal weight women are being diagnosed with Type 2 Diabetes in spite of being normal weight and not seeming to have the traditional risk factors for diabetes. Perhaps they have a poor body fat composition. This can be tested by DXA analysis at Women's Health Practice. In an article about this condition in the Mayo Clinic Proceedings they looked at the factors that cause the condition they now call the 'metabolically obese normal weight' individual and found that diet was the most important reason individuals find themselves in this condition, and for overall health we feel this diagnosis is critical. The key points in the article were that it is possible to be obese, and have too much body fact and be normal weight,  we have to use alternative definitions for metabolic obesity to identify these patients and help them resolve their condition, because they are at risk for cardiovascular disease, but we know it increases risks of many other conditions including migraines. For those women who have not been tested for this condition, we encourage them to have a consultation at Women's Health Practice.

5. Supplements:

When it comes to supplements, there is no one size fits all. At WHP we rely on your health history, your lifestyle, your nutrition and your testing to really help answer the questions regarding supplement use. And what is most important is to watch the research as it is rapidly evolving. One quick guideline is to definitely normalize your magnesium, and for some migraine sufferers that means getting pharmacologic, not physiologic dosages. At WHP, would like them to try the newest sleep combos as normalizing sleep often helps migraine treatment improve as well: melatonin (5 mg), zinc (11.25 mg), and magnesium (225 mg).

6. Pregnancy:

Migraines, your overall nutrition, your pregnancy hormone levels, and the types of medications you can use will all affect your risk of migraine worsening in pregnancy. Migraines in pregnancy can also be a risk factor for stroke, and unfortunately young women with obesity are having strokes during pregnancy in a rising number of cases. We have thought of this strokes as a disease of the elderly, there are two types but essentially the issue is lack of blood to part of the brain. Strokes are also very deadly. Women with high blood pressure are at risk, and so are diabetics,and those with high cholesterol,  other factors lead to clogged blood vessels can predispose a woman to stroke. There are conditions called thrombophilias that are essentially genetic conditions that alter clotting factors and increase risks like DVTs, heart disease, and stroke. This is how your gyno can help you prioritize when you are going to get pregnancy, and help you prevent pregnancy if you are working on your health first! Migraine management is an important part of this formula as you could also be at risk for other conditions that may be affected by migraines including thec onditions of preeclampsia, eclampsia, congenital heart disease, sickle cell anemia and migraines that can drive stroke risk as well Fertility and sex drive are both lower with high cholesterol, so risk of stroke and prevention of migraines is not the only reason to get your cholesterol in check as part of your wellness care, gyno before pregnancy can test you for them to see if you have one of these conditions. It is important to learn the signs of a stroke, and to realize that calling 911 is the best strategy if a woman thinks she is having a stroke.  Pregnancy planning visits are the best way to prevent many adverse outcomes, including migraines. There are many new guidelines regarding diabetes control, blood pressure control, medication prevention of preeclampsia, as well as overall dietary management and blood factor screening that can help you have a happy and healthy pregnancy.

7.Early Menopause:

Normal menopause is after the age of 40, and premature menopause, or very late menopause will affect your contraceptive risks according to your age. If you were safely using your pill, and now you have your 35th birthday, you may be surprised to know your gyno may view your risks in a whole different category. For most all women on oral contraception the risks are low, and it is acceptable to use your pills until menopause, and even into early menopause for some. If you smoke, if you become ill with a medical condition that is a contraindication to pill use, or have special considerations from your gynecologist, you may indeed have to be taken off the pill prior to the time of menopause, whether you have migraines or do not have migraines. Women in their late 30s and 40s can most likely stay on a contraceptive pill that is working for them. Smokers should not be on the pill after the age of 35. The CDC talks about contraceptives and their risks in benefits in their publications, the last being in 2013. If you have migraines you may also need to come off your combination oral contraceptive pills if you are over the age of 35. It is not known what is the average age of loss of fertility and ACOG and NAMS recommend women continue contraception until menopause or until the age of 50-55. Natural fertility, on average, wanes after age 41, but pregnancies are still possible much older, up to, about  age51. Furthermore oral contraception pills can control the irregular cycles of perimenopasue and other menopausal symptoms, and prevent women from having some of those wild hormonal fluctuations that can contribute to migraines.. Studies of breast cancer and birth control pills have been conflicting In general there are only weak links if linked at all. It appears that women over 40 or over 45 (depending on which research studies) have increased risks of breast cancer if they stay on the birth control pill. The important factor is to get on the contraceptive that works best for you and your lifestyle, and to do that the best, as we always say you should gab with your gyno yearly!

8. Exercise:

In general exercise is going to be an important part of your gyno's recommendation for controlling migraines, but there are patients who suffer from exercise induced migraines.  This may be related to other factors, and other aspects of your nutrition. For instance Vitamin C management can show strong improvement in many aspects of your health including your overall levels of inflammation, your headaches, and your exercise performance. Consider how this could help. You might be a candidate for Myer's Cocktails.

9. Genetics:

We know that your pharmacogenetics will govern how you respond to pain medication, and this will intern determine how well you are relieved by medication, or whether you are on a medication that can actually become toxic in your system. some women may be relieved by adding folic acid to their diet, but others it doesn't work. The reason may not just be the amount or the brand of medication. There may be a deeper reason that that and it could be up to your gyno to go deeper into your personal body chemistry. It is possible that your genetics do not allow for proper processing of your b vitamin pathways. Find out what your b vitamin pathways are participate in the Radar Study at Women's Health Practice.

9. Prescriptions:

Well aware that medications interfere with pregnancy and contraception, your gyno is well suited to help sort out competing prescriptions. Sometimes medication adjustments have to be made considering all these factors!

10. Botox

Already in a skin regimen that uses Botox? Or in one that doesn't? Your gyno at Women's Health Practice can discuss with you whether, based on your cycles, your contraception, your moods, and your headaches, perhaps we should think about whether to incorporate Botox, and whether to use the migraine treatments, along with your cosmetic treatments. All the botulinum toxins should work for migraine benefit, but only Botox brand has been studies. The use of onabotulinimtoxinA (Botox) has been used by injection for the treatment of migraines and tension headaches. The injections can be placed in one or more of several locations depending upon the severity of the symptoms and the location of the symptoms. Individual consultation is best when determining the amount of Botox injected, and the frequency of repeat injections. After many studies  evidence-based review published in 2008 by the American Academy of Neurology (AAN) concluded that botulinum toxin is probably ineffective for the treatment of single episode of migraine, this was reaffirmed in 2010, and 2016. Medical evidence that  Botox injection is effective for the treatment of chronic migraine, with some types of migraines responding better than others and in women your injector at Hada Cosmetic Medicine could help discuss this. Actually women are often successful. It seems to reduce the frequency of the headaches by 20-50%, and can be an excellent strategy if injected by an experienced injector. Based on some studies that were not as favorable, many insurance companies do not have this as a covered service, but it is sometimes possible that health savings plans can cover these services.

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Thank you for your comments and questions. This blog is not intended to replace medical care, but is informational only. We hope you will become a follower or visit Womens Health Practice. We offer a variety of unique services including MonaLisa Touch, Coolsculpting, Labiaplasty, and Gynecoloigic Clinical Research Trials. For more information on menopause see http://www.amazon.com/Menopause-Make-Peace-Change

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