Menstrual migraines that occur in the days following menstrual bleeding may be related to low ferritin caused by blood loss rather than to estrogen fluctuations according to research led by Anne H. Calhoun, MD, from the University of North Carolina and Carolina Headache Institute–Research, Durham. As she states;
“End menstrual migraine (EMM) is a common complaint in women evaluated for menstrual related migraine, yet these migraines occur many days after the estrogen withdrawal that precipitates menstrual-related migraine,”
“[We] believe that end menstrual migraine is not hormonally mediated, but rather that it is causally related to menstrual blood loss, resulting in a brief relative anemia with consequent migraine,” the researchers add.
Menstrual Blood Loss
The study was prompted by the researchers’ clinical observations that some patients being treated for regularly occurring menstrual migraine experienced the migraines at the end of menstruation.
“We suspected a relationship to menstrual blood loss and have been routinely checking ferritin levels for this complaint for a few years,” they report.
They evaluated data on 119 consecutive patients seen over 6 weeks at the clinic.
Among 85 women with regular menses who were appropriate for evaluation, 30 (35.3%) had EMM. Their mean EMM duration was 2.6 days, with the headache graded as severe on at least one day.
Of the 30 patients, as many as 28 (93.3%) showed levels of ferritin, an intracellular protein that stores iron and releases it in response to tissue demand, to be below the generally accepted lower desirable limit of 50 ng/mL (mean, 21.9 ng/mL). Of those women, as many as half had levels below 18 ng/mL, the established minimum for women.
“While adequate iron levels are certainly important, adequate iron stores are equally important, [and] with inadequate ferritin, these iron stores can quickly be depleted,” the authors note.
The researchers also note that chronic headache is a recognized symptom of low ferritin levels.
The authors call for larger epidemiologic studies to confirm the prevalence of EMM and to better characterize the disorder.
They recommend the following diagnostic criteria for EMM: (1) predictable migraine headache (with or without aura) that (2) occurs immediately after or toward the end of menstrual bleeding.
Richard Katesmark comments ; “ Various mineral & vitamin deficiencies have been identified over the years as potential causes, or contributors, to migraine. Intuitively it would make sense that regular post-mentrual headpain may be related to iron levels. So if you fit the above criteria for EMM it may be worth trying a good quality ferritin supplement for a few months & see if it helps “
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