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If you’ve ever felt like the inside of your skull was under attack, with pulsing, throbbing pain, severe nausea, and an intense sensitivity to light that left you crawling to the nearest dark room to curl up in bed- you’ve likely experienced a migraine.


Thanks to fluctuating hormones, women are more likely to experience migraines; 1 in 4 women will suffer through at least one in their lives, according to the Migraine Research Foundation. Even worse, most migraines go undiagnosed and untreated with only about 500 certified headache specialists in the U.S.


If you suffer from chronic migraines, know there are preventive treatments available. The key, says Dr. David Lans, D.O., at Integrative Rheumatology of Westchester, New York, is stabilizing hormones.


“For some women, menopause brings relief from migraines as estrogen levels diminish. For others, however, menopause can bring on an increase in migraine frequency,” says Dr. Lans. “Fluctuating levels of hormones, typical in perimenopause and early menopausal states, can actually result in an increase in migraine frequency and intensity.”


Instead of resigning yourself to years of migraine misery in perimenopause, talk to your doctor about these everyday strategies to find relief:


  1. Consider bioidentical hormone replacement therapy. “One approach is to stabilize hormone levels, since fluctuations in estrogen seem to be responsible for migraines in perimenopausal women,” says Dr. Lans. “This can often be accomplished with bioidentical (natural) hormones, carefully administered, and may be preferable to medications used to treat migraines, which can have side effects.”


  1. Stay away from oral estrogens. Estrogen replacement can be administered in cream, patch, or pellet form, and Dr. Lans discourages women in his practice from taking oral estrogen: “Oral estrogens can increase blood lipids and clotting factors that impact cardiovascular health, and may also increase migraine frequency.”


  1. Turn to nutritional supplements. For some women, even bioidentical hormone replacement therapy (BHRT) can trigger migraine attacks. For these patients, Dr. Lans will make every effort to continue BHRT because of its many benefits, and treat migraines independently. “There are a number of natural strategies we can try before considering pharmaceutical products,” says Dr. Lans. “These include nutritional supplements such as magnesium, riboflavin (vitamin B2) and CoQ10, and botanical remedies feverfew and butterbur.”


  1. Try acupuncture therapy. Researchers in China found that classical acupuncture may help prevent recurring migraines. This study published in JAMA Internal Medicine reports that properly administered acupuncture reduced the frequency of migraine attacks in participants 18 to 65 years old.


  1. Consider pharmaceuticals as a last resort. If natural strategies aren’t working, Dr. Lans recommends asking your doctor about beta blockers, antidepressants, calcium channel blockers, and anticonvulsants. Medications used to treat migraines can come with unwanted side effects, but for some women, pharmaceuticals may be necessary to prevent and treat chronic migraines. “Botox injections are often quite effective as well,” he says.


If you suffer frequent migraine attacks, don’t just pop pills to stop the pain. Dig deeper with your doctor to discuss ways you can support your body as you transition into menopause- and stop migraine attacks in their tracks.

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