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Focus on Women's Health Hormones and
Headache . . . .
In the United States, 1.4 percent of all visits to office-based
physicians is due to headache,which represents approximately
12 million physician visits in one year. According to recent
studies, 8.7 million females and 2.6 million males in the
U.S. experience migraine. Only about one-third of female headache
sufferers have ever consulted a physician for their headache
problems. The headache attacks greatly impact on the ability
of women to work and pursue everyday life activities.
Migraine onset typically occurs about the time of puberty,
and its prevalence reaches a peak before menopause, and the
frequency decreases thereafter. Headache ratio between females
and males at age 20 is about 2 to 1, and about 3.3 to 1 between
ages 42 to 44. It decreases to about 2.5 to 1 by age 70. This
pattern underscores the link between hormones and headaches
in women. In this section, we will review topics of interest
to female headache sufferers starting with the treatment of
menstrual migraine.
Menstrual Migraine
Up to 70 percent of female migraine sufferers describe a relationship
to their periods. The attacks occur either before, during,
or immediately after their flow. Also, some women will complain
of headaches at the time of ovulation. These menstrual headaches
are related to fluctuations in hormone levels which regulate
the menstrual cycle. All of the events in the normal female
life cycle that are associated with varying sex hormone levels
(estrogen, progesterone) menarche (initial onset of periods),
pregnancy, birth control pill use, menopause, and hormone
replacement therapy may cause a change in the frequency, severity,
duration, and complications of headaches.
Most female migraine patients report a decrease or remission
of their headaches after the first trimester of pregnancy.
Treatment
For those patients complaining of headaches at the time of
their periods, treatment can be complicated. Remedies that
may be beneficial at other times of the month will be unsuccessful
at period time. If the individual only experiences headaches
during her periods, she may be reluctant to take medications
the remainder of the month which could prevent the attacks.
In menstrual migraine, the agents of choice are the nonsteroidal
anti-inflammatory agents (NSAIDs). This group of drugs includes
over-the-counter agents, such as ibuprofen (Advil®, Nuprin®,
Motrin IB®), naproxen sodium (Aleve®), and ketoprofen
(Orudis®). It is essential that the agents are started
2 to 3 days prior to the onset of the period, and continued
through the flow. The NSAIDs prevent clumping of the platelets,
believed to be a factor in migraine, and swelling. Because
these drugs are being used for a limited time, the usual complaints
of stomach distress are minimal. The prescription NSAIDs most
often used for menstrual migraine include fenoprofen calcium
(Nalfon®), naproxen (Naprosyn®), nabumetone (Relafen®),
and ketorolac (Toradol®). If one NSAID is ineffective,
another type of NSAID should be tried.
For those whose headaches do not respond to the NSAIDs,
small doses of ergotamine agents may be used. These ergotamine
agents have been used for decades in migraine treatment. These
agents must be prescribed by a physician. When used for menstrual
headache, the agent can be at bedtime or twice daily. One
of these drugs, Bellergal-S®, contains ergotamine as
well as phenobarbital and belladonna alkaloids, and is administered
2 to 3 times a day, starting 3 days before and continuing
through the menstrual period. Other agents used in menstrual
migraine prevention include methylergonovine maleate (Ergonovine®)
and dihydroergotamine maleate (D.H.E.-45®), and methysergide
(Sansert®). Estrogen administered via transdermal patches,
applied to the skin immediately before menstruation, may be
effective.
If you have any specific questions or would like information
on menstrual headaches or other hormonal headaches, please
contact the Diamond Headache Clinic: clinic@diamondheadache.com
or 1-800-HEADACHE.
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