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.
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.
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.
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.
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.
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.
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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