Health

What Causes a Migraine, and What Relieves the Pain?

Hormonal Effects on Migraines

Based solely on the significantly higher number of women suffering from migraines compared with men, it appears that female sex hormones have a significant influence. Further evidence of the impact of female hormones on migraine incidence comes from the most common age range for migraneurs: 15 to 55 years old, corresponding roughly to menarche (first period) and menopause. In fact, before puberty, girls and boys have an approximately equal likelihood of having migraines.

In one study of women going through the menopausal transition, roughly 60 percent of women with headaches (both migraine and tension-type) had no more headaches after menopause, and only 14 percent of postmenopausal women reported migraines. Additional population studies saw similar findings.

What you describe—premenstrual migraines—is a significant subset of migraines as a whole. Four to twelve percent of women with migraines have them only in the two days before or after the start of the period; an additional 50 percent of migraineurs have menstrually related migraines, or migraines that occur more frequently around the start of the period, but can occur at any time during the cycle.

 

Treatment of Migraines

Lifestyle changes. Doctors offer lifestyle modification as a first line of action for management of many medical problems: If you have high blood pressure or diabetes, lose weight by exercising more and changing your diet; if cholesterol is high, eat less red meat, etc.

Creating a management plan for your migraines should first involve something relatively simple: Every time you have a headache, write down in a journal how much sleep you had the night before, what you ate and drank that day, where you were, whether you were exposed to any toxins or unusual fragrances, and anything else you can think would be pertinent. Bring this journal with you to the doctor so that the doctor and you can look for triggers and ways to avoid those.

Get more sleep. Begin slowly to increase your sleep by 15 minutes each night, with a goal of achieving one hour more every night. (I know it’s hard to get everything done in the limited time you have!)  The price you pay for doing all those demanding things each night is an increase in stress, decrease in quality sleep, and an increase in migraines, all of which decrease your ability to function at work and at home.

Avoid alcohol completely. (Your glass may help with stress at that moment, but if it leads to a bad migraine, is that really worth it?)

Eat a balanced diet. Avoid foods that are known triggers for migraines, and certainly foods that trigger your migraines.

Exercise regularly.

Try relaxation therapy. This kind of therapy, which includes meditation, breathing exercises, and progressive muscle relaxation, can be effective, with reports of 50 percent reductions in both migraine pain and frequency.

Try abortive therapy (medications given at the start of a migraine, to stop it) The most important part of abortive therapy is timing: As soon as you feel the headache beginning, take medication to stop it. But don’t take abortive medications too frequently: generally, avoid taking over-the-counter agents more than 2 or 3 times a week and prescription drugs more than 2 times per week. Taking these medications too frequently can lead to chronic headache syndrome (called medication-overuse headache). Once a patient develops this problem, it can be difficult to solve.

Non-prescription meds like ibuprofen (Advil), acetaminophen (Tylenol), and naproxen (Aleve), with or without caffeine (Excedrin Migraine) are frequently effective in stopping a migraine.

The most commonly prescribed abortive drugs used today are in a class of drugs called triptans. These medications activate serotonin receptors on cranial blood vessels (blood vessels in the brain) and cause them to constrict, stopping blood vessel dilation before it is too far along. If you wait too long to take a triptan, the migraine may be past the stage where vessels are dilating and into the stage where nerve endings have become hyperactive.  At this point it becomes difficult to control the pain. Triptans are prescribed less frequently in people who suffer from migraine with aura, due to the increased risk of stroke in this group of patients. While triptans are not associated with stroke, they could theoretically worsen a stroke by causing constriction of blood vessels that are already compromised in their ability to deliver oxygen to an at-risk part of the brain.

Preventative therapy. When migraine frequency or severity increases to the point that it is significantly interfering with work, school, or life in general, preventative medications are often recommended.

In the most recent guidelines from the American Headache Society and the American Academy of Neurology, first-line therapy includes: metoprolol, propranolol, and timolol (beta-blockers); valproic and and topiramate (anticonvulsants); butterbur (an herbal drug). These medications have secondary effects, which can be both helpful and harmful. For instance, propranolol and timolol can help treat high blood pressure, while topiramate generally leads to weight loss. Butterbur can help decrease symptoms of hay fever, but also causes GI issues.

Needless to say, choosing a management and treatment plan for a neurologic condition must be discussed with your doctor. The good news is that there are many options for treatment that you probably have not tried, and many of these, including non-drug therapies, are very likely to decrease your migraine frequency and severity.  And you are right about menopause and migraines.  Your migraines , which occur more often with change in the menstrual cycle, are very likely to decrease or disappear after menopause.

Baxter Allen, M.D.

 

 

Links
Cleveland Clinic, Relaxation Techniques
The American Headache Society
The National Headache Foundation

Sources
Brandes, Jan Lewis. The Influence of Estrogen on Migraine. JAMA (2006); 295 (15): 1824-30.

Goadsby, Peter J. Pathophysiology of Migraine. Ann Indian Acad Neurol (2012); 15 (Suppl 1): S15–S22.

Modi, Seema and Dionne M. Lowder. Medications for Migraine Prophylaxis. Am Fam Physician 2006;73 (1):72-78.

Loder E, Burch R, and P Rizzoli. The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and   Comparison with Other Recent Clinical Practice Guidelines. Headache 2012; 52: 930-945.

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  • Andrea Rosenhaft June 17, 2019 at 7:51 am

    I’ve had severe and chronic migraines for about 9 years. I’m 58 years old and 6 years post-menopausal. Amovig (140 mg) has been a life-changing medication for me, especially since I can no longer use triptans as I had a stroke in 2018. I’m seen at a major headache center in the Bronx, NY. In addition to the Amovig, I get Botox injections every 3 months and nerve block/trigger point injections every 2 weeks. I take Topiramate as a preventive medication. My mother also had migraines and became addicted to Fiorcet as there was not much available to help her. I’ve become aware of my triggers – the first being a drop in barometric pressure, which I can’t control and the second, stress, and the third, being missing a meal and/or a snack. Those are the top three. Recently I had extensive oral surgery on my lower jaw and that triggered a migraine for as long as it took my jaw to heal which was more than a week. Unless a person has actually experienced the excruciating pain of one, they don’t understand and tend to downplay it as “just a headache.”

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