I have suffered from migraines most of my life. I finally found a great deal of relief when I had a hysterectomy five years ago. Before that, I went through the maze of medicines, and all I ended up with was a life full of pain and reactions. Since my surgery I have gained my life back. My mother went through the same thing. My daughter has had migraines since she started her monthly periods. Now, after three children, she has had her tubes tied, and right on schedule her migraines are increasing in frequency and intensity. Would a hysterectomy possibly help her?

A.

Migraine headaches have a definite genetic link, over half of migraine sufferers have a family history of migraine headaches. They are also more common in women. Migraines are caused by abnormal blood flow in the outer portion of the brain, triggered by a combination of factors. Known migraine triggers include low serotonin levels, food allergies, histamine containing and releasing foods, alcohol, chemicals like nitrates and MSG, stress, intense emotions, muscle tension, weather changes, eyestrain and in women hormonal changes, especially those associated with menstruation, ovulation, premenopause and use of oral contraceptives. While migraine headaches usually have an initial onset in ages 10-30, many women start having migraine headaches associated with menstruation in the late 30Ýs and early 40Ýs. The incidence and frequency of migraine headaches is related to inherited tendency to abnormal blood flow combined with one or more triggering factors.

There are many alternative approaches to decreasing migraine headaches including the elimination of food allergies (most common are dairy, wheat, egg and citrus); elimination of histamine containing or histamine releasing foods like chocolate, cheese, beer and wine; supplementation of vitamins B6, B2 and C, magnesium and essential fatty acids; elimination of histamine breakdown inhibitors like artificial colors and birth control pills; stress reduction and relaxation techniques; supplementation of 5-hydroxytryptophan and/or the herb, feverfew; and in women, balancing of hormonal levels with diet, herbal supplements and enhanced liver function. A combination of these will produce the best results.

There are several new medications for migraines that may not have been available for you. Many of the traditional migraine medications like ergot derivatives, caffeine and various analgesics ( pain killers) have side effects and can actually increase the incidence of migraine over time. The newer medications act to alter serotonin binding and work well for many people. In addition to the alternative approaches, frequent and severe migraine sufferers will probably want to try one of these medications for acute pain relief.

Since migraines in women can be triggered by hormonal changes, especially as they get older, a complete hysterectomy with the removal of the ovaries (and thus the hormones) might be helpful for some. However, estrogen replacement therapy needed for the menopause symptoms caused by ovary removal or for prevention of osteoporosis may trigger migraines again. In addition, since there are many other triggers of the migraine like foods or stress, complete hysterectomy may not be an effective treatment. Since hysterectomy is a major surgery that has its own health risks, I would consider it as a last resort if all other treatment options fail.

Since headaches can be caused by other problems besides migraine, new or more frequent headaches should be evaluated by a specialist, even when there is a history of chronic migraines.

Your daughter may need to consult with several specialists in order to develop the best treatment plan for her. A naturopathic physician or alternative medical doctor can guide her with alternative treatments; a neurologist will be helpful for prescribing medications for pain relief and to determine if other problems are causing increased and more frequent pain; and an endocrinologist and/or gynecologist can work with hormonal imbalance and help her evaluate the benefits and risks of a hysterectomy.

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