Bad Headache or Migraine

You may be surprised that information on headaches and migraine are included on this site, but they are very common in people with pelvic pain.

It’s always best to talk about your headaches with your doctor first, as serious disease is possible. There are many types of headaches and if you are unsure what type of headache you may have, you will find information to help you at:

http://www.adelaide.edu.au/painresearch/headache/dandt

Two types of headache that do seem to be particularly common in people with pelvic pain are:

 – low grade background headaches that may represent chronic inflammatory changes in the body that drive chronic pain and headache.

 – migraine headaches which are more common in women than men.

Migraines are probably more common in women because of hormonal differences. One common trigger for migraine is the changes in oestrogen level with periods. It may also be that oestrogen hormones prime pain pathways to make headache more likely. Women who have had endometriosis seem to have even more severe and troublesome migraines on average than other women.

Girls and boys have fairly similar rates of headache until puberty, but after puberty three times as many girls are affected as boys.

It is often overlooked that children can get migraines too.

None of these treatments suit everyone, so you may need to try more than one to find something that suits you best. It is worth the effort, though. Your headaches are unlikely to go away by themselves and life is better without headaches.

Headaches with periods

A headache that comes each month with a period often improves with one of these options:

• A  iucd in the uterus
• A diclofenac 100mg suppository
• A ‘triptan’ nasal spray available from your doctor, or,
• An estrogen hormone patch used at period time

A low grade headache for several days each month

Sometimes they may be severe, while at other times just a nuisance.  It is definitely worthwhile trying a preventer medication taken every day. Helpful medications in young women include:

• Amitriptyline 5-25mg 3 hours before bed each day
• Cyproheptadine (Periacten), 2 to 4mg each night
• Other medications from your doctor, or explained in our book

Try each one for 2-3 months and keep a headache diary, so you can  decide if it has helped.

Migraines at other times

Make a plan with your doctor and ask about a ‘triptan’ nasal spray.

There is much more information on headaches in our book, and at www.migraineclinic.org.uk

Unfortunately, this has led to some women having drastic hormonal and gynaecological manipulation, generally with poor results.  For most patients, hormonally related migraine is still best treated in a conventional manner using the types of migraine treatment for most patients.  However, in certain cases collaboration between a headache specialist and a gynaecologist can produce the best results.  For some women with migraine, the attacks are very much more likely to occur around the beginning of the period than at other times and this is called menstrual migraine.  It seems to be triggered by the drop in the blood levels of the female hormone oestrogen at around the time of the period.  This can be partly helped by hormonal treatment which may include the oral contraceptive but needs to be done carefully as it also may make the condition worse.  It is not clear why headache may be more common in patients with chronic pelvic pain.  However, current research at the University of Adelaide suggests that there is a low grade of inflammation in the brain which predisposes to chronic pain and these can drive both chronic pelvic pain and headache.  It is possible that treatment directed at this mechanism might help both conditions.