Women and Migraine

Thank you to Sheena Aurora, MD, FAHS for her contribution to this spotlight!

Gender Bias…Is Anatomy Destiny?YoungCoupleEmbracing

Migraine is more common in little boys than girls until they reach puberty. Then in adolescence, girls surge ahead. By then, three times more females than males experience migraine. In about half of teen girls, migraine is associated with their menstrual cycle. The change in prevalence is thought to be related to fluctuations in hormones, which may make girls more susceptible to migraine. Over a lifetime, migraines in women are often associated with hormonal shifts—such as during menstrual cycles, pregnancy, and menopause. The articles in the section will show you how hormones influence migraine.

During puberty, two main hormonal systems become active: gonadoptropic-hypothalamic-pituitary-gonadal axis, which ultimately stimulates the release of estrogen, progesterone, and testosterone which in turn directly affect neuronal networks in the brain, and hypothalamic-pituitary-adrenal axis: the circuit that starts, regulates, and stops a stress response.

If you’re interested in more scientific information on female hormones and how they work in migraine:
http://www.sciencedirect.com/science/article/pii/S0969996114000692
http://clinicalevidence.bmj.com/x/systematic-review/0318/overview.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311830/

Many thanks to Nada Hindiyeh, MD

Maybe a Migraine

No question that for some women, there’s a connection between estrogen levels and migraine attacks. The cyclical changes in female sex hormones, particularly the premenstrual drop in estrogen level, are hypothesized to trigger these attacks. If you have pure “menstrual migraines,” they will occur exclusively during the five-day menstrual period and in two out of every three menstrual cycles—not at other times during the month. Additionally, women who get menstrual AND non-menstrual migraine attacks may have more severe, longer duration attacks during menstruation. These menstrually-related attacks may be more refractory to medications compared with nonmenstrual attacks.

So, shouldn’t treatment just be a matter of stabilizing estrogen levels? Unfortunately, it doesn’t always work that way. Taking estrogen has demonstrated mixed results. Even oral birth control pills have an unpredictable impact on migraine. In some women, they can decrease migraine frequency, trigger an attack, or do nothing at all.

What can you do to make it better?

Treatment for menstrual migraines can include the same medications used for non-menstrual migraines. In women with regular menstrual cycles, short-term preventive medications such as non-steroidal anti-inflammatory drugs1  (some over-the counter products like aspirin, ibuprofen (Advil© or Motrin©, naproxen like Aleve©) or prescription medications may help.

In all cases, though, you should consult your health care professional or a migraine specialist about diagnosis and treatment of menstrual migraine.

If you want to know more: http://www.thejournalofheadacheandpain.com/content/15/1/30
Or this one that includes some suggestions for reducing the discomfort: http://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/in-depth/headaches/art-20046729

Many thanks to Gwyneth McCawley, MD

[1]AMF does not endorse any products for use in migraine. You should discuss these with your healthcare professional.

The Good News…And the Other Good News

If you have migraines, there’s a good chance they’ll improve during pregnancy. Researchers say 50-80% of women who’ve had migraines before pregnancy may notice an improvement. That’s because estrogen levels rise in pregnancy and may exert a preventive effect, especially in the second and third trimesters.

Studies show that one-third of women get better during pregnancy, particularly if they have menstrually associated migraine and pregnantwomananother third of the women stay the same. However, some women get migraines for the first time during pregnancy and they may be more severe.

But, even before pregnancy, there are a few things you need to do to make sure your baby and you are as healthy as possible, even if your migraines don’t improve.

According to Sheena Aurora, MD, Clinical Associate Professor, Neurology & Neurological Sciences at Stanford School of Medicine and Chair of the American Headache Society’s Scottsdale Headache Symposium Program Committee, women with migraine who are hoping to get pregnant should consider their options before they get pregnant.

A recent NIH-sponsored study done by the Swedish Medical Center in Seattle found that women with migraine are more at risk for vascular complications, had more sleep abnormalities, and seemed to be more overweight during pregnancy.

“Keeping this in mind,” she says, “we ask our migraine patients to take better care of their high blood pressure and cholesterol and to stop smoking before they get pregnant. As migraine specialists, we try to collaborate with their obstetricians, a perinatologist and even a pregnancy pharmacologist, if needed.”

Dr. Aurora and her team also ask patient to take a good look at their life style.  Consider nutrition, hydration, exercise and sleep.  “We also ask them to recognize stressful situations and consider use of stress relaxation, meditation, yoga or massage,” she says.

Is There Anything Good About Menopause?

Hot flashes, night sweats, insomnia, irregular periods, vaginal dryness, mood changes, weight gain, thinning hair, dry skin…

Is there anything good about menopause? Well, if you have migraines, maybe.

isthereanything_SmallTwo-thirds of women with migraine will experience a significant improvement in their migraines with menopause, especially if they have migraine without aura. Some women even stop getting migraines once they reach complete menopause, assuming menopause is natural and not as the result of surgery or other induced causes.

Yet in some women, migraines may worsen in the perimenopausal period, the time just before menopause when your body is transitioning to menopause. This happens because of major fluctuation in estrogen levels as your body moves through the change.

In fact, migraines may get worse or more prevalent in women who have had menstrually related migraines during their life or in whom menopause has been induced because of surgery or medical treatments like chemotherapy.

Hormone replacement therapy (HRT)—medications containing female hormones like estrogen that replace the ones the body no longer makes—may help these women. Transdermal formulations, such as a skin patch, are often preferred to taking HRT pills. The not-so-good news is that HRT pills can sometimes worsen migraines and patches may provide little or no benefit.

Either way, you should consult a healthcare professional who can work with a migraine specialist to find the right approach for you.

If you want to know more:
http://www.ncbi.nlm.nih.gov/pubmed/25449663
http://www.ncbi.nlm.nih.gov/pubmed/24867840

Many thanks to Nelli Boykoff, MD

Headache Journal Toolboxes for Women and Migraine

These toolboxes appear in Headache, the journal of the American Headache Society®.

Pregnancy and Lactation – Migraine Management – April 2015
Menstrual Migraine – February 2014
Menstrual Migraine – October 2009