| Q: |
Is migraine more common in women?
| | A: |
Population studies show that prior to puberty, boys have the same
number or slightly more attacks than girls. After puberty, girls begin
to experience more attacks than boys due to an increase in estrogen
levels. Studies demonstrate that more women than men report experiencing
migraine. However, since these studies use strict diagnostic criteria
for migraine, it is likely that many men with migraine are omitted
because their attacks do not always meet these criteria.
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| Q: |
How can hormones affect migraine?
| | A: |
The hypothalamus in the brain regulates the hormonal changes that
occur during a woman’s menstrual cycle. The hypothalamus controls the
release of hormones from the pituitary gland. Some pituitary hormones in
turn control the release of estrogen and progesterone from the ovaries.
The coordinated cyclic flow of hypothalamic and pituitary hormones
stimulating the release of sex hormones is part of a normal menstrual
cycle. A fall in estrogen levels prior to menstruation is believed to
lead to migraine attacks.
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| Q: |
How does menstrual migraine differ from other types of migraine?
| | A: |
Migraine attacks associated with menstruation are particularly
severe and last longer than other types of migraine. They usually last
2–3 days, with nausea and vomiting as prominent symptoms. The majority
of attacks occur in the 2 days before the first day of menstruation or
on the first day of menstruation. The attacks are usually fairly
constant, occurring with each menstrual cycle; however, some women may
not experience a migraine with every cycle.
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| Q: |
What about the use of oral contraceptives?
| | A: |
Women who have migraine must avoid the use of oral contraceptives
if they have other risk factors for stroke. Migraine without associated
risk factors for stroke is not an absolute contraindication for the use
of oral contraceptives. The decision to use oral contraceptives must be
made in consultation with your doctor.
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| Q: |
Can I take oral contraceptives to stop menstruation to treat menstrual migraine?
| | A: |
Yes, you can. When you take oral contraceptives without stopping
to have menstrual period you prevent the drop in estrogen that triggers a
migraine attack. However, you will need to stop taking them
intermittently to have a normal cycle. You will also need to discuss
this alternative treatment for menstrual migraine with your doctor.
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| Q: |
Why do so many women in their mid-30s to mid-40s have migraine?
| | A: |
The prevalence or percentage of women in their mid-30s to mid-40s
with migraine is much higher than at any other time of life. This is
due to hormonal changes, busy lifestyles, and progression of the disease
over time. Many women find it a very difficult time to stop and treat
their condition because they are so busy. It is important that you do
not allow the frequency of the migraine attacks to increase; making time
for yourself and the treatment of your illness is therefore crucial.
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| Q: |
I have tried medications in the past for migraine but I gained
weight. Is there a way I can prevent migraine and not gain weight?
| | A: |
Yes, you can. In fact, by following an effective migraine
prevention program you are likely to lose weight. Newer medications for
migraine prevention are less likely to cause weight gain, and reducing
your intake of carbohydrates can reduce headache frequency. Daily
exercise helps you control your weight as well as your migraine attack
frequency.
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