Post-Menopausal Migraines: Symptoms, Causes, and Treatment Options

Q: Post-Menopausal Migraines: Symptoms, Causes, and Treatment Options

Hello： Your symptoms are likely indicative of a mixed headache. <br>Given the presence of localized tender points, tension-type headache should be considered first. <br>The symptoms of tension-type headache include： (1) Typically bilateral, located in the occipital and parietal r

Chronic headaches

Hello, I have just gone through menopause for two years and am experiencing some mild symptoms.
Before menopause, I occasionally had migraines (often on the right side, sometimes severe enough to cause vomiting, with overall weakness and loss of appetite, requiring a few days of rest before feeling better).
I do not take pain medication; after vomiting and lying down, I feel somewhat better.
However, now that I am in menopause, these episodes still occur occasionally, sometimes once a month.
If the weather is hot, I am more prone to them.
The pain is located on the right side of the back of my head, the right temple, above the right eyebrow, and along the right nasal bridge (it feels like a circle).
The symptoms are a dull ache, not severe pain, but uncomfortable, and sometimes I feel nauseous but cannot vomit.
I still do not take pain medication because it is bearable, just uncomfortable (and the episodes are irregular).
I have noticed a bony protrusion on the right back of my head, exactly where the pain point is, and pressing on it causes pain (which worries me).
I would like to ask what my symptoms might indicate.
Additionally, I have had blood tests in recent years that showed slightly elevated EB virus IgA antibodies, but I have no other discomfort symptoms (I have checked the symptoms of nasal cavity cancer).
I am just curious about what might be causing my headaches.
Which specialist should I see? Gynecology? Otolaryngology? Neurology? Or is it unnecessary? Are there any methods for improvement? Thank you for your response!

Janice, 50~59 year old female. Ask Date: 2018/09/28

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms are likely indicative of a mixed headache.
Given the presence of localized tender points, tension-type headache should be considered first.
The symptoms of tension-type headache include: (1) Typically bilateral, located in the occipital and parietal regions, sometimes with widespread pain.
The nature of the pain is dull, pressure-like, or tight, without pulsation, with tightness and stiffness in the occipital-cervical area, which is more pronounced when turning the neck, with intensity ranging from mild to moderate.
(2) There are tender points in the muscles at the pain site, and sometimes pulling the scalp can also cause pain; the muscles may feel stiff, and one or more nodules, known as myofascial trigger points, may be palpable.
(3) It does not interfere with daily activities; for example, walking or climbing stairs does not exacerbate the headache.
(4) Fatigue, tension, excitement, anxiety, insomnia, or depression can worsen the headache.
Pain may be triggered by flexing and extending the head.
As for migraine symptoms, they are primarily related to your premenstrual headaches, which typically last from 4 to 72 hours.
The characteristics of migraine include: unilateral headache, which feels like throbbing or pulsating pain, often accompanied by a heartbeat or pulse sensation, severe pain may lead to nausea and vomiting, and sensitivity to light and sound; moreover, walking, climbing stairs, or head movements can exacerbate the headache.
Many patients require analgesics or preventive medications for relief.
In addition to pharmacological treatment, lifestyle adjustments are also very important.
This includes developing good habits, maintaining a regular daily routine, ensuring adequate but not excessive sleep, avoiding overexertion, and relaxing.
Some individuals may have specific triggers, such as certain foods, alcohol, drastic temperature changes, or moving in and out of air-conditioned rooms during hot summer days; avoiding such situations can help prevent migraines.
It is suggested to try drinking a cup of coffee in the morning to see if it changes the headache condition, as two-thirds of people may experience relief.
I recommend that you consult a neurologist to discuss examination and treatment options.
Wishing you good health, peace, and happiness.
Dr.
Jiang, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2018/09/28

More Info

Understanding post-menopausal migraines can be quite complex, especially considering the hormonal changes that occur during and after menopause. Migraines are a type of headache that can be debilitating and are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Your description of the symptoms, particularly the location of the pain and the associated nausea, aligns with typical migraine presentations.

Symptoms of Post-Menopausal Migraines
1. Location and Nature of Pain: You mentioned that the pain is primarily on the right side of your head, affecting areas such as the back of the head, temples, and above the right eyebrow. This unilateral pain is characteristic of migraines. The sensation of "dull pain" rather than sharp pain can also occur in migraines, especially in the post-menopausal phase.

2. Associated Symptoms: Nausea and vomiting are common in migraine sufferers. The fact that you experience these symptoms, along with the headache, further supports the possibility of migraines.

3. Triggers: You noted that warmer weather seems to trigger your migraines. Environmental factors, including temperature changes, can indeed be triggers for many individuals. Other common triggers include stress, certain foods, hormonal changes, and sleep disturbances.

Causes of Post-Menopausal Migraines
The hormonal fluctuations associated with menopause can significantly impact migraine frequency and intensity. Estrogen levels drop during menopause, which can lead to changes in the frequency and severity of migraines. Some women may experience an increase in migraine attacks during this transition, while others may find that their migraines decrease after menopause.

Treatment Options
1. Lifestyle Modifications: Since you mentioned that you can tolerate the pain without medication, it might be beneficial to explore lifestyle changes that could help reduce the frequency of your migraines. This includes maintaining a regular sleep schedule, staying hydrated, managing stress through relaxation techniques, and avoiding known triggers.

2. Over-the-Counter Medications: While you prefer not to take pain medication, over-the-counter options like ibuprofen or acetaminophen can be effective for managing mild to moderate migraine pain. However, it’s essential to use these medications judiciously to avoid rebound headaches.

3. Prescription Medications: If your migraines become more frequent or severe, it may be worth discussing prescription options with your healthcare provider. Medications such as triptans, which are specifically designed to treat migraines, may be beneficial.

4. Preventive Treatments: If migraines are frequent, preventive medications may be considered. These can include certain antidepressants, anticonvulsants, or even Botox injections, which have been shown to reduce the frequency of migraines in some patients.

When to Seek Medical Attention
Given your symptoms and the recent discovery of a bony prominence at the pain site, it would be prudent to consult a healthcare professional. You may want to start with a neurologist, as they specialize in headaches and migraines. They can perform a thorough evaluation, which may include imaging studies like an MRI or CT scan to rule out any underlying conditions.

Conclusion
In summary, your symptoms are consistent with post-menopausal migraines, and while lifestyle changes may help, it’s essential to consult a healthcare provider for a comprehensive evaluation and tailored treatment plan. Migraines can significantly impact quality of life, and effective management can help you regain control over your symptoms.

Similar Q&A

Understanding Menstrual Migraines: Causes, Treatments, and Solutions

In my childhood memories, my mother had symptoms of migraines, but in recent years, possibly due to menopause, she suddenly recovered without medication. Now, it seems to have become my issue. About three years ago, I would mostly experience migraines after riding my bike in the ...

Dr. Zhuang Zhijian reply Obstetrics and Gynecology
As you mentioned, it could be premenstrual syndrome (PMS). It is advisable to get more rest and supplement with vitamins to alleviate the symptoms. If necessary, medication can be used to address specific symptoms.

Self-Care Strategies for Post-Menopausal Women: Addressing Sleep and Hormonal Issues

Hello Dr. Chang, I have two concerns I would like to consult you about: 1. Sleep and tinnitus, 2. Hormones. I wake up at 3 AM and find it difficult to fall back asleep. If I do manage to sleep again, it is only for a short time and filled with dreams. This situation began after ...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, if you have experienced improvement in your symptoms after using Veenina tablets and sedatives, but are not suitable for hormone replacement therapy due to the risk of thrombosis, you may try the methods you mentioned to see if they are effective. However, if your symptoms...

Managing Migraines: Tips for Better Care and Sleep Balance

Hello Dr. Lin: A family member of mine frequently suffers from migraines, and I haven't found a better way to care for her. I can only tell her to rest more, but I'm also concerned that too much sleep might affect her health. Recently, she mentioned that she has become ...

Dr. Lin Zijing reply Neurology
Migraine is the most common type of headache disorder, with the highest prevalence occurring in individuals aged 35 to 45 years. Women are three times more likely to suffer from migraines than men. The characteristic feature of a migraine is severe, pulsating pain localized to on...

Managing Menopausal Symptoms: Concerns About Medication Side Effects

From the age of 52 to 59, due to menopause, I have been experiencing head pressure and pain, particularly in the forehead area, often accompanied by neuralgia. I also hear sounds while sleeping, have photophobia, and experience a grinding noise in my brain, making it difficult to...

Dr. Wu Enliang reply Psychiatry
Hello, the dosage of the medication is quite low, so it should not cause side effects. These two medications are also not addictive. However, the previous medication, Stinose, has a high potential for addiction. Dr. Wu Enliang.