Three times more women experience migraine headaches than men, according to the American Migraine Foundation, and the Migraine Research Foundation reports about 18 percent of all women experience migraine headaches.
Migraines are notorious because of their potential severity and associated effects, such as sensitivity to light or sound and nausea or vomiting. “Migraine is a disorder of recurrent attacks,” says Adriane Spruell, a certified adult nurse practitioner with The Orthwein Brain and Spine Center at St. Luke’s Hospital. “It’s a type of headache with a combination of symptoms. The pain is usually moderate to severe and has a significant impact on a person’s ability to perform their regular daily activities.”
Women can blame a lot on their hormones, and one of the more unpleasant side effects of being female is menstrual migraines. While estrogen levels aren’t the only thing that triggers migraine headaches in women, they are a significant factor for many, notes Dr. Rachel Darken, a neurologist for Washington University in St. Louis.
“If you look at when women tend to get migraines, it often starts going up in terms of prevalence around the time girls start having periods and tends to go down in prevalence around menopause,” she says. “So for a lot of women, in terms of migraine triggers, the menstrual cycle can be significant.”
Migraines tend to run in families, and other common triggers include stress, sleep disturbances and particular foods. Even the weather can trigger a migraine, Darken says. “Barometric pressure changes are a big trigger, and in St. Louis, we seem to experience those regularly, especially at certain times of the year.” As winter turned to spring, with its swings between weather extremes, Darken noticed an uptick in calls about severe or frequent migraines.
Tracking and identifying migraine triggers can be key to prevention. Sadly, this may include avoiding chocolate, wine or cheese, which are among the more common food triggers. And although women can’t avoid their hormones, if migraines clearly are related to changes in the menstrual cycle, then some hormonal therapies, such as oral contraceptives, can be helpful for some women.
“Preventive treatment, which consists of daily measures and medication to help eliminate headaches over time, is usually considered when headache frequency or severity increases to a point when it is significantly interfering with work, school or social life,” Spruell says. “The choice of preventive agents should be individualized according to patient-specific characteristics. For example, Botox is an effective treatment for those with chronic migraines, which consist of 15 or more ‘headache days’ a month for at least three months.”
Migraines often respond well to ibuprofen and naproxen, two types of over-the-counter nonsteroidal anti-inflammatory medications, Darken notes. “They’re more likely to work the earlier in the headache that you take them,” she continues. “However, there’s something known as ‘medication overuse headache’ – if you take acute pain medications too frequently, they can actually make headaches more frequent and severe. So we recommend not taking an acute medication for headache more than two days a week.”
For those who find that over-the-counter remedies aren’t enough to control their headache symptoms, prescription medications are available to help with pain and nausea. “When headaches are impacting a person’s ability to perform their activities of daily living, they should seek treatment,” Spruell says. “Those with debilitating headaches should have a plan in place and effective medications to use when they get a headache. The goal is to improve function and quality of life.”
Darken adds that lifestyle measures are also important in preventing and controlling migraines. She advises going to bed and waking up at roughly the same time regularly, even on weekends, and getting enough sleep. Eating regularly and staying hydrated, as well as getting regular exercise, are other helpful habits.
A new type of treatment also is on the horizon and may be approved by the U.S. Food and Drug Administration within the next year, Darken notes. Recent research has supported the use of calcitonin gene-related peptide antagonists. “This is completely new and novel,” Darken says. “We don’t have any approved medications out there right now that work through this mechanism.”
Regardless of your specific triggers, if you suffer from migraines that affect your ability to enjoy life, there are resources available, Spruell says, adding: “If someone is experiencing any type of headache – even if it is a migraine a few times a month – know that there are specialists available to help you and walk you through treatment options to best fit your needs.”
Orthwein Brain and Spine Center at St. Luke’s Hospital, 232 S. Woods Mill Road, Chesterfield, 314-205-6060, stlukes-stl.com
Washington University Physicians, wuphysicians.wustl.edu