With women making up the majority – 28 of 39 million - of American migraine sufferers, we can safely say that migraine is a women’s health issue.
Experience caused the team at the Headache Center to identify a connection between migraine in women to hormonal shifts from their menstrual cycle, menopause and pregnancy. As a result, we launched the first programs in the region addressing the unique needs of these patients.
Migraine facts:
- Before puberty, boys are affected more than girls, but during adolescence, the risk of migraine and its severity rises in girls. When they hit their reproductive years, as many as 45% of women suffer from migraine.
- About 1 in 4 women will experience migraine in their lives.
- Three times as many women suffer from migraine in adulthood as men.
- About half of female sufferers have more than one attack a month, and a quarter experience four or more severe attacks each month.
- More severe and more frequent attacks often result from fluctuations in estrogen levels, yet not all migraines are hormonal.
- More than 90% of women with severe migraine are disabled.
The Hormone Factor
Women experience migraine differently than men – the pain reportedly lasts longer and happens more frequently for them. Changes in estrogen levels due to menstruation, hormonal contraception, pregnancy and menopause often cause more severe and frequent migraine attacks.
Menstrual migraine
Menstrual migraine starts up to two days before and up to three days after a woman’s period begins, possibly due to estrogen withdrawal and hormonal fluctuations. Affecting 7 to 19% of women this can be severe and more difficult to treat. Many women also don’t respond as well to treatment during their period.
About 60% of women affected by menstrual migraine also have migraine at other times during the month. Treatment is generally the same as for other types of migraine, but if the menstrual migraine is so severe that it doesn’t respond, hormonal contraceptives might be used as treatment. Sometimes, we will prescribe contraceptives that reduce or eliminate periods to treat severe menstrual migraine.
Hormonal contraception
Hormonal contraception – oral, vaginal, patch or injection – can cause increased pain in women who suffer from migraine or keep the pain at bay with fewer headaches. In some, oral contraceptives can trigger the first migraine attack, especially in women with a family history of migraine.
Women with migraine should be careful when choosing a hormonal contraceptive, and weigh the risks and benefits of a particular contraceptive with their provider.
Pregnancy
Pregnancy is also a time to plan for women who have migraine. Some migraine medications may impact the ability to conceive or even harm the fetus. For about 60% of pregnant migraine sufferers, there is significant improvement during the first trimester, and more than 75% of women find they improve or even disappear during the rest of their pregnancy.
Unfortunately, about 15% of women report their migraines worsen during the first trimester, and about 25% notice no change. Usually, sufferers will return to their pre-pregnancy migraine patterns after their baby is born, although regular nursing may delay the return of migraines.
Menopause
Menopause and the years of perimenopause before it can be a time when migraines worsen due to the intense hormonal fluctuations. But, migraine frequency tends to decrease significantly when menstruation ends and hormones stop fluctuating.
Migraines will improve or go away entirely in 67% of sufferers, and women who go through natural menopause often find their migraine symptoms improve dramatically. Women who experience a surgical menopause do tend to suffer more because they take estrogen replacement therapy.
Later life
Later life (after 60) in women sees the prevalence of migraine drop to just 7.5%. Few sufferers have their first migraine after age 65. If that happens, it’s important to consult with your provider to rule out other medical problems.