NOVEMBER 2003 MEETING

TOPIC:  “HORMONES AND HEADACHES”

L. Sandy Hughes, MD, was the guest speaker for the November 11, 2003 meeting of the East Bay Headache Support Group.  The meeting was held in the Ball Auditorium with 24 people in attendance.  Dr. Hughes is an obstetrician/gynecologist with a private practice in Walnut Creek.

How do we know that hormones are involved in headaches?  Predominantly estrogen.  Dr. Hughes stated that before puberty, boys and girls have the same frequency of headaches.  But after puberty, the incidence of headaches, typically migraines is much higher in the female sex.  Many women note that their headache frequency peaked at around age 40.

Migraine without aura--first day of period.

Tension headache--during ovulation.

Perhaps not estrogen, but perhaps caused by a drop in body temperature, or drop in LH hormone.  Estrogen either helps or causes headaches.

Lupron turns off the pituitary gland, so creates medical menopause.

Q.        Menopause headache--how to treat? 

A.        Dr. Hughes said to try hormone replacement therapy to see if a continuous level of estrogen helps your headaches.

He’s comfortable with prescribing HRT (hormone replacement therapy) for years for a woman going into menopause and experiencing symptoms.

Q.        An audience member stated she was 40 and wondering if perhaps her estrogen level is low.  Maybe estrogen is causing problems with vascular symptoms instead of nerves.

A.        It takes two to three months to get rid of estrogen when taking Lupron.  Use as a last resort, said Dr. Hughes.

Q.        Birth control pills are almost all synthetic.  In HRT, we have estradiol and promethium (progesterone) which are hormones.  They mimic what your body makes.

A.        It’s a matter of what works for you.  New vaginal ring for estrogen--like a .1 mg patch.  You can have an endometrial biopsy once per year.  Can do a low dose patch and take promethium for 10 days, but then have a period only once every three months.  Endometrial cancer is easy to control, but you have to have a hysterectomy if you get it.

Q.        If I stop taking birth control pills, how long to get them out of my system to see if they could be menstrual migraines?

A.        About a month.

Q.        What is FSH?

A.        Follicle Stimulating Hormone (FSH).  In menopause, FSH and LH levels go up, and that’s probably what causes hot flashes.

Q.        Could FSH and LH be the cause for headaches in menopause?

A.        It’s possible, but Dr. Hughes couldn’t find any studies about it.  Replacing estrogen with HRT reduces FSH and LH levels so reduces hot flashes.

Q.        Depo-Provera:  how does it work? 

A.        Every three months you get a shot.  Some side effects are weight gain, water retention, but it is good for endometriosis.  It may cause more headaches (but Dr. Hughes said most of his patients who use Depo-Provera don’t complain of headaches).

Q.        Issue of stroke and migraine, stroke and pregnancy, stroke and birth control pills.  Dr. Stein asked, “What is the risk of stroke?

A.        Dr. Hughes answered, “The risk of stroke is double if you take birth control pills and your getting more migraines (though the risk is still small).  The risk of stroke in pregnancy is not great.  It is probably best not to use triptans during pregnancy.

HRT study was of women who were 63--was trying to see if estrogen helped heart disease.  It takes about ten years before breast cancer is detectable.  Risk is like driving, only less.  Dr. Hughes doesn’t think magnitude of risk is worth having a bad quality of life.  This whole story is not done--he expects more in the media.

Q.        Dr. Stein commented that one speaker promoted Prozac or anti-depressants for headaches.

A.        Dr. Hughes answered that if you’re depressed, yes you should use Prozac.  But if you’re not, don’t take Prozac just for the headaches.  He wouldn’t use an antidepressant as a first line of defense in treating headache.  Serafem, used for PMS, is just Prozac.  Zoloft has been found to be effective intermittently.

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.