Three times as many women as men suffer from migraine. From triggers and treatment to impacts of menopause and what hormones have to do with it, here’s what you need to know about this disabling condition.
Those who suffer from migraines may be familiar with their unwelcome symptoms. The severe headache. The nausea. The vomiting. The blurry vision or blind spots. The difficulty in concentrating. The loss of speech.
What you may not realise is that the vast majority of migraine sufferers are women. Dr Amanda Newman, Jean Hailes specialist women’s health GP, says three times as many women as men experience them.
More than 20% of people in Australia suffer from migraine and 7.6% of people in Australia experience a severe form of migraine known as chronic migraine, defined as 15 or more migraine days a month.
A migraine is much more than a severe headache. It is a disabling condition that can have a significant impact on the person’s health and wellbeing. Migraine episodes can sometimes last for days.
There are two main types of migraine:
Aura refers to a collection of sensory disruptions such as flashes of light, blind spots, or tingling and numbness in the hands and face.
Conditions that affect the blood vessels in the brain, such as stroke, are associated with migraine with aura. If you have migraine with aura, you have a slightly higher risk of stroke. Looking after your cardiovascular risk factors such as high blood pressure, diabetes and not smoking, are important.
There is a hormonal component to women’s migraines but that is not the whole story. The whole story is not known."
Dr Amanda Newman, Jean Hailes specialist women’s health GP
“Until a few years ago, it was thought that migraine was related to spasms in the blood vessels on the outside of the brain," says Dr Newman.
“We now think that although spasm does happen, it’s not the cause. The cause is related to various chemicals that affect the nerves in the brain.
“We know there is a genetic connection. If you have a family history of migraine, you are more likely to get it.”
There are a number of migraine triggers including stress, anxiety, changes in sleep patterns, bright lights, as well as certain foods and beverages. These include wine, chocolate, certain cheeses, and citrus fruit. Dehydration is also a trigger.
Different people may have different triggers, but “if you think a particular food makes the migraine worse, avoid it,” advises Dr Newman.
Research shows that many people with sinusitis (inflammation of the sinuses, often causing pain) are actually experiencing migraine or another type of headache. Sinusitis (also known as sinus headache) is the most common incorrect diagnosis given to someone who really has migraine. So how do you tell the difference?
In a Jean Hailes health professional webinar on the topic of migraine, London-based expert Professor Anne MacGregor says there are three questions to ask yourself:
If you answered yes to at least two of these questions, you’re 93% likely to suffer from migraines.
If you are suffering from what appears to be a severe migraine and it’s unusual for you, Dr Newman says it’s important to see your doctor. “If it’s unusual for you, don’t assume it’s migraine.”
Not all severe headaches are migraine. Curiously, some migraine sufferers, says Dr Newman, have headaches that are either mild or non-existent.
The connection between hormones and migraine is not fully understood. However, in the Jean Hailes health professional webinar, Prof MacGregor says that women who experience a natural menopause – one that is reached without surgical or medical means – will be more likely to see an improvement in their migraine with time.
About 67% of women with migraine will improve with time following a natural menopause.”
Professor Anne MacGregor, MBBS, FSRH
She explains that the factor that aggravates migraine is surgical menopause – when surgery rather than the natural ageing process causes a woman to go into menopause. “Even when the ovaries are left in place and women only have their womb removed, that still increases the likelihood of migraines worsening,” she says
She adds that if a woman has both her ovaries and her womb removed, she could experience a significant increase in migraine, and that will need to be managed. Dr Newman says it’s safe for most menopausal women who suffer migraines to take menopausal hormone treatment (MHT). It is safer to use oestrogen patches or gel rather than tablets.
Migraine with aura can increase the risk of stroke in women taking the oral contraceptive pill.
Although there is no cure for migraine, prescription and over-the-counter-medications as well as complementary approaches, such as yoga, meditation, and acupuncture, can treat or even prevent symptoms.
Dr Newman says it’s helpful to take paracetamol (eg Panadol) or an anti-inflammatory drug (eg Nurofen) as soon as you feel a migraine coming on. Nausea (a feeling of sickness) is common with the onset of a migraine episode so it’s also a good idea to take an anti-nausea drug which will help with the absorption of the medication.
“In most people, that works,” says Dr Newman. However, she issues a note of caution. If you use pain-relieving medications too often – around 15 times a month – this can provoke headaches.
There are migraine-specific medications which your GP or your neurologist may prescribe. This class of medication is known as Triptans and are usually recommended for people with moderate to severe migraine attacks.
Dr Newman says there are five types of Triptans available for use and you may need to try several to find the one that works best for you. “Your GP or your neurologist will guide you on this,” she adds.
If you suffer from frequent severe migraine attacks – more than three a month – you might be prescribed a medication that prevents a migraine, to break the cycle. Dr Newman says there are a number of options available, but they must be continued for at least three months.
There is evidence, she says, to suggest that yoga, meditation, and acupuncture can help. So too can seeing a psychologist who uses cognitive behaviour therapy (CBT).
“Botox is also a legitimate treatment and useful if simpler measures are not working,” says Dr Newman. “Botox alters the neurotransmitter pathways in the brain, and we think migraines are caused by these pathways not working properly.”
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