| Melanie is not alone. “Migraine occurs three times more commonly in women than in men because headaches are triggered by hormone changes which occur frequently in women,” explains Kelley Lester-Garrett RNP. “Women’s hormones change at puberty, with monthly cycles, with pregnancy, at menopause and with the use of therapeutic hormones for birth control or for other reasons. 60% of women with headaches also suffer attacks related to their menstrual cycle.” Only 10% of women have headaches only with menses. Therefore, in most women, hormones are just one of many migraine triggers that need to be controlled to achieve headache–free living. Menstrual headaches require special treatment strategies in addition to the standard strategies of trigger identification and avoidance, and the use of medications to prevent or treat attacks. If the attacks are predictable, short-term preventive therapy can be started one to two days before the anticipated headache. Non-steroidal anti-inflammatory agents can be used for a few days around the period and help reduce headache pain as well as menstrual cramps.Stabilization of hormones may also benefit the migraines. This may include an estrogen patch or estrogen pills taken the week of the period. Daily attack aborting medications taken around the period may also reduce the headaches. Switching to a long cycle oral contraceptive is a good strategy for some. It can reduce the menses and associated headache problems to only four predictable times per year.” As women near menopause, the estrogen levels may fluctuate more and trigger an increase in migraines. Daily preventive therapy may again be necessary if the headaches are frequent and the periods are unpredictable. Women who go through natural menopause may have fewer headache problems than women having hysterectomies. In menopause, the use of continuous estrogen replacement without any days off helps to minimize migraine for many women. The dose should be the lowest effective dose. Dr Teixido and I always try to minimize the dosing of medications to minimize side effects for our patients.” Dr. Teixido has partnered with Kelley Lester-Garrett FNP to open a headache treatment site that can help to meet our community’s needs. “Having a team approach can insure that important aspects of migraine care are not ignored. Hormone management is not a regular part of my ENT practice but is important to address for optimal results in headache treatment. My patients have been comfortable addressing this aspect of their problem with Kelley and have benefitted greatly from it. By addressing hormone problems our patients with migrainous vertigo also do better”. Dr. Teixido is a Delaware native. He is the director of the Balance and Mobility Center of Christiana Care, the Cochlear Implant Program of Christiana Care and of the Delaware Otologic Medicine and Surgery Fellowship training program. He teaches ear medicine and surgery regularly at Thomas Jefferson University where he is Assistant Professor, at the University of Pennsylvania, and at Drexel University, as well as nationally and internationally.  Kelley Lester-Garrett BSN, MSN, FNP-C, received her Bachelor’s Degree in Nursing in 1992 and her Master’s Degree and Family Nurse Practitioner certification in 2008 from University of Delaware. She has worked in various nursing roles including: neurosurgical and medical intensive care, home care, and school nursing. Kelley regularly attends national and international conferences on headaches. She is a member of the American Headache Society and the American Academy of Nurse Practitioners.
For more information about migraine simplyGoogle: Teixido Migraine. Dr. Teixido, MD, and Nurse Practitioner Kelley Lester-Garrett see patients at
Suite 210 1941 Limestone Road
Wilmington, Delaware. Call 302-998-0300 for an evaluation. | 
