From the Research
Menstrual vestibular migraines may improve after hysterectomy in some women, but this outcome is not guaranteed and varies significantly between individuals. Hysterectomy (removal of the uterus) with or without oophorectomy (removal of ovaries) can help when hormonal fluctuations are clearly triggering vestibular migraines that coincide with menstruation. The improvement occurs because hysterectomy with oophorectomy eliminates the cyclical hormonal changes, particularly the fluctuations in estrogen and progesterone that often trigger these migraines 1. However, hysterectomy is considered a last resort treatment and should only be considered after less invasive options have failed.
Before considering surgery, patients should try preventive medications like topiramate (25-100mg daily), propranolol (40-160mg daily), or amitriptyline (10-50mg daily), as well as hormonal treatments such as continuous birth control pills to eliminate hormone fluctuations 2. Vestibular rehabilitation therapy and lifestyle modifications including trigger avoidance may also help manage symptoms. It's essential to note that if the ovaries are preserved during hysterectomy, hormonal fluctuations will continue, potentially maintaining the migraine pattern.
Additionally, surgical menopause from oophorectomy carries its own health risks, including increased risk of cardiovascular disease and osteoporosis, which must be weighed against potential migraine benefits 1. The use of gonadotropin-releasing hormone agonist (GnRH-a) therapy, alone or with "add-back" therapy, has also been shown to be effective in treating severe menstrual migraine headaches 3. However, the most recent and highest quality study on this topic is from 2018, which suggests that maintaining a stable estrogen environment with estrogen replacement can benefit estrogen-withdrawal migraine, particularly in women who would also benefit from relief of vasomotor symptoms 1.
Some key points to consider include:
- Hysterectomy with oophorectomy may eliminate cyclical hormonal changes that trigger migraines
- Less invasive options, such as preventive medications and hormonal treatments, should be tried before considering surgery
- Surgical menopause from oophorectomy carries health risks that must be weighed against potential migraine benefits
- GnRH-a therapy, alone or with "add-back" therapy, may be effective in treating severe menstrual migraine headaches
- Maintaining a stable estrogen environment with estrogen replacement can benefit estrogen-withdrawal migraine.