Migraine in Women
In 1991, Dr. Richard Lipton and colleagues studied the prevalence of migraine in the United States, and found that approximately 18% of women have migraine compared to 6.5% of men. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999, which is consistent with the growth of the population. This translates to approximately one in four households containing at least one member suffering from migraine, or 18 million American women having migraine. The question begs to be asked…“Why is migraine more common in women than men?”
Although exact reasons are not clear, one possible reason may be hormonally based. Women have fluctuating hormones that cycle monthly. This includes rising and falling levels of estrogen. Interestingly, in 1972 Dr. Sommerville and colleagues first reported that falling estrogen levels, as we see prior to the start of a woman’s menstrual cycle, were associated with migraine. Indeed, hormones may play a role in why women experience migraine almost three times more often than men. This is further supported by finding that before puberty, both boys and girls have the same migraine prevalence. However, once puberty arrives, the frequency of migraine between girls and boys separates and becomes almost three times more common in females than males.
What can you do if you think you might have migraine?
- Schedule an appointment specifically for headache evaluation A separate physician appointment should be scheduled for and dedicated to the evaluation of headache, and headache alone. When headache is discussed during an office visit for other medical concerns or after an ob-gyn exam, there may not be enough time or attention to properly assess the headache.
- Be Prepared to provide the necessary informationThe physician needs to know specific and detailed information about the headaches in order to determine the proper diagnosis and treatment plan.
Women can be prepared for the interview by:
- Symptoms: Track your migraine symptoms and be prepared to provide information about the pain location, character, and associated symptoms (e.g., nausea, vomiting, light sensitivity).
- Patterns and characteristics: Follow the onset and history of your headache symptoms over time. This will help determine any patterns or triggers, such as menstruation, travel, allergies or stress.
- Medications: Record all medications (both prescription and over-the-counter) that you are taking, and recall past treatments and their outcome that you take or have taken for headache. Also, record other possible triggers that may impact headache such as caffeine, vitamins, or dietary supplements.
- History: Learn about any possible family history of headache. Migraine often runs in families and this will help confirm a diagnosis.
- Illnesses: Provide the necessary information about other medical conditions that may influence your headaches—such as depression, sleep irregularities or eating disorders.
Talk to your doctor
- To ensure that women are able to communicate effectively with their physician during the appointment, they should arrive early and bring notes, questions, a headache calendar, medical records or other information. If possible, arrange child care so that you can devote full attention to the visit. Most patients feel more comfortable talking to their physician when they are wearing their street clothes. If the nurse suggests that you change into the examination gown, it is reasonable to request that you sit with the physician first to discuss headaches.
- It is important that you are in a comfortable environment so you may interact with the physician without distractions. All women need to be sure they understand exactly what the diagnostic and treatment plans are, and how the treatment plan will be evaluated over time. Don’t hesitate to make a list of questions and items you want to talk to your doctor about. The list of questions or concerns will help you be prepared learn more about your headaches and how to treat them.
- Provide reliable feedback
The physician will be relying on the headache patient to provide feedback about the effectiveness of treatment. It is crucial to discuss the impact headache has on one’s life. We know that physicians are much more likely to respond with more appropriate and aggressive treatment if patients describe the impact their headaches are having on their life.
- For example, “Doctor, my headaches prevent me from working three days each month” goes further than just describing pain intensity and location. Often treatment plans have to be modified over time, and reliable information is needed. Carefully follow all treatment recommendations, and report progress back to the physician as requested. The physician (and the headache sufferer) should be interested in tracking success of treatment over time.
- Know what to expect Headache patients need to make sure they share their treatment goals with the physician. Remember, headache is a chronic medical condition that can rarely be cured. The goal is to manage headaches, and allow the headache sufferer to function more normally. Treatment expectations need to be realistic, as migraine is not a curable disorder, but rather, one that can be managed with a treatment plan (like diabetes, high blood pressure, and heart disease). Patients need to be educated about headaches. There is a great deal that women can do to ensure that they receive the best possible medical care.
Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646-57.