Migraines, Menstrual Cycles, and Lupus Flares: A Painful Trifecta

I dread that time of the month. Lupus has made it even worse – both the dread and the experience. Some menstrual cycles are more painful or inconvenient than others. Yet, after 15+ years of having periods, I’m still learning about new problems they can cause.

It’s never been easy. I’ve never had a simple relationship with my period. First, I was a late bloomer. Then in college, I didn’t have one for my entire freshmen year, which led to tests and my diagnosis of polycystic ovary syndrome (PCOS). I continued to have wildly irregular periods, which doctors thought would lead to fertility problems.

I was able to conceive two children naturally, although it took a while for my first child. However, my period changed after having kids; I think my uterus wanted payback for what I put it through. I started to have more severe cramps and experience the kind of pain that I’d heard others describing for years.

Periods and migraines

This past year I was gifted a new period problem: migraines. I experienced my first migraine during my second pregnancy and the following year, after giving birth, they started to arrive in droves. So I went for a CT scan, saw a neurologist, learned a great deal about migraines, and was prescribed a couple of migraine medications.

I also started keeping a headache and migraine diary, which helped me see how my migraines are often intertwined with my hormones. My guess is that I used to get period headaches and they somehow evolved into migraines.

Now when I know my period is coming, I also know to expect a migraine. They are slightly more regular these days. While I don't want a migraine, it helps to have an idea of when I'll be less capable. Sometimes, I get migraines when I ovulate, since estrogen levels surge at that point too. Due to all the tracking, I noticed my lupus joint pain flared up around this time as well.

I don’t know if the lupus flares are also hormone related or if they tag along behind the physical stress of the migraines, but it’s not a fun trifecta.

Which came first, the migraine or the lupus flare? My health problems have multiplied over the years, which is common with autoimmune diseases. And when I simultaneously suffer a migraine, period cramps, and lupus pain, I fear that these stressors will start up yet another new health issue.

How to treat my migraines?

If I could tolerate birth control, this would be a good time to try one that helps regulate hormones. For some women, tampering down hormones has helped with migraines or other period-related health issues. Birth control has been an unmitigated disaster for my lupus, and I’m unwilling to try again.

I have 2 breakthrough medications that I can take when a migraine begins. These treat active migraines and are more effective when they’re taken as soon as symptoms appear. Unfortunately, I often can't take them right away because I'm taking care of my kids.

I also have a preventive medication I should take every 4 weeks. It's an injection - much like my Cimzia - but it is meant to stop migraines from happening in the first place. The pain from this injection is unreal and it's been hard to comply with using it; I’m doing my best. I think I'll be able to use my meds more effectively over time.

I’m also learning about migraine triggers, especially things like overusing NSAIDs and Tylenol, and will soon complete my first 6-month-long migraine and headache diary.

I recently completed a trial of low-dose ketamine for depression, which was highly encouraged by my neurologist since ketamine can also help migraines. As I put the ketamine dates into my migraine diary, I noticed that they aligned with a huge gap in my migraines. The ketamine was good for my overall health, so I’m glad to have another tool in my arsenal against that time of the month and everything else that comes with it.