Women are three times more likely than men to suffer from migraines. Lisa Jewell examines the causes of migraines and looks at ways of coping with the condition

Migraine is one of the most misunderstood conditions, mostly because only sufferers truly know the severity of pain that accompanies a migraine attack.

Unfortunately, women are much more likely to know the dreaded feeling of an oncoming migraine. The fairer sex is three times more likely to suffer from migraines than men.
This is due the hormonal changes that happen to women, including fluctuating oestrogen levels during menstrual cycles and the menopause.
That’s not to say that hormones cause migraines- which are actually caused by neurological factors- but they can bring on attacks in people susceptible to migraines.

What are migraines?

Migraines are often dismissed as ‘just headaches’ but if you’ve ever experienced a migraine, you’ll know the difference!
Migraines usually start with a headache that’s confined to on one side of the head and can be severe and throbbing. The headache is often located behind one of the eyes and is usually accompanied by nausea and sensitivity to light.

Around one in three people experience migraine aura before the headache arrives, the most common symptoms are visual disturbances like blind spots or flashing lights. Some people experience pins and needles on one side of their body during a migraine aura.
While common headaches can quickly clear up, a migraine can last between four and 72 hours if left untreated.

Causes

A migraine occurs when the usual balance of chemicals in the brain is altered, causing blood vessels to expand. In turn, they have an effect on surrounding tissue and irritate nerve endings.
It’s thought that genetics have a major influence in determining who experiences migraines. Recent studies show that 60 % of sufferers have a family history with their mother, being the most commonly effected relative.

Effects

It’s estimated that at least 400,000 Irish people are effected y migraines. They can have quite an impact on the day- to-day life of sufferers-affecting their work life, social life and family life.
The World Health Organisation classifies migraine as the 12th leading cause of disability amongst women and 19th amongst both genders.
The average migraine sufferers (also known as migraneur) looses two days from work every year because of their condition. And a survey by the Migraine Association of Ireland revealed that almost half of all respondents felt discouraged  from socialising due to migraine.

Diagnosis

If you suffer from regular headache or what you believe might be a migraine, you should get it checked out with your doctor or ask to be referred to a specialist.
In rare cases, a migraine or headache might be a symptom of an underlying condition and an MRI or CAT scan will determine whether that is the case.

Migraine is still hugely under-diagnosed-it’s believed that 50% of all migraine sufferers remain undiagnosed.
It really is worth getting a diagnosis as it can help you access effective treatments and workout what is triggering your migraines.

Treatments

Esther Tomkins, a clinical nurse specialist in migraines at Beaumont Hospital in Dublin, says that migraneurs can be divided into three groups.
“One third of people find they can treat themselves using over-the-counter products, another third go to see their GP and another third have severe migraines and attend a specialist clinic,” she says.
There are two main ways to medically treat a migraine- take preventive medication or else take painkillers.

If you regularly suffer from migraines (meaning two or three attacks a month), you’ll probably be advised to take some form of preventive treatment.

This means taking a daily tablet or capsule that will reduce the frequency, severity and duration of migraine attacks. You will probably need to take this preventive medication for a certain period of time before you start to see it working.
Painkillers reduce the effects of a migraine once it has kicked in. Some people find that over the counter painkillers work fine in treating their migraine but there are other drugs, called Triptans available through prescription. These are painkillers but they also target certain receptors in the brain that are linked to migraine attacks.

Managing your symptoms

If you’d rather not go down the drug route or want to try something alongside medication, there are plenty of alternative ways to help relieve pain and symptoms.
They include yoga, reflexology, self-massage, exercise and acupuncture. In fact, a German study in 2006 revealed that acupuncture might be as effective as medication in the treatment of migraine.

The research followed people who each had between two and six migraines a month. One group had traditional acupuncture and were found to have 50% less migraine days. Those in the group who were given medication had a 40% less reduction in their migraine days.
Many people find that lying down or going to sleep can help migraines. Other ways to relieve a migraine include drinking plenty of water, getting some fresh air and wearing sunglasses when there is bright sunlight (as it’s known to be a trigger for some migraneurs).

Know Your Triggers

Triggers don’t cause migraines but they bring about attacks in people who are already susceptible to getting migraines.
While there are some well known migraine triggers, not everyone has the exact same triggers and some people don’t seem to have anything in particular that sets off their migraines!
The most common triggers are:

• Perfume
• Caffeine
• Chocolate
• Wine
• Cheese
• Tiredness
• Skipping meals
• Lack of sleep
• Stress

Keeping a diary can help migraine sufferers to identify what their triggers are and this means they can eliminate or avid them in their daily life.

Did you know?

The highest prevalence of migraine occurs in women aged 35 to 45, which is a time in life when many women are at the height of their professional career and often have to balance it with family responsibilities. Talk about bad timing!

The hormone connection

Migraine is a neurological condition, which means it originates in the brain an central nervous system. So while hormones can have an influence on migraines, they aren’t the original culprits!

Puberty

Migraines in children are relatively rare, though before puberty, boys and girls are equally likely to experience migraines.
However, one the teenage hormones kick in, girls are much more likely to suffer from migraine attacks and these usually coincide with the onset of menstruation.

In fact, girls are more likely to begin having migraines during the same year of their first period than at any other age.

Menstruation

The time of the month can bring lots of delightful experiences- like stomach cramps, bloatedness and irritability. Unfortunately some women get to add migraines to their list of period side-effects.
Around 60% of women with migraine notice that they have more migraine attacks around the time of their menstrual period.

There is also a small group of women who are known to have ‘pure menstrual migraine’. This means that they only ever get migraines around the time of their period and at no other times of their cycle.
The reason why periods can bring on migraines is not exactly clear-cut. However, it seems that the rising and falling levels of oestrogen and progesterone trigger a chance in the body that can affect the normal balance of brain chemicals and can therefore start off a migraine.

The pill

Women who experience migraine can take the contraceptive pill, as it isn’t contraindicated.
Many women don’t see a significant chance in their migraines after beginning on oral contraception but for some fortunate ladies, the migraines aren’t as bad as they were before.

In some cases, a woman’s migraines might actually become more frequent and severe while they are on the Pill. If so, they should talk to their doctor about changing to another type of oral contraception so that levels of hormones in the body are adjusted.

Pregnancy

Those nine months of pregnancy can actually have a bonus effect for migraine sufferers.

Many women report that their migraines seem to get less severe or disappear while they are pregnant- this is due to the fact that hormones seem to stabilise during the gestation period.
“The majority of women find that they are migraine free during pregnancy- especially during their second and third trimesters when their hormones are more balanced,” says clinical nurse specialist in migraines, Esther Tomkins.

“Unfortunately, women usually find that after they have their baby, their migraines can come back again as hormone levels change.”
If you are pregnant and are suffering from migraines, there isn’t a huge amount that can be done in treating them. The only painkiller that is deemed safe to be taken during pregnancy is paracetamol- all the others are big “no nos.”

In some rare cases, doctors may have to prescribe something to a pregnant women who is suffering from bad migraines but it is not something that’s generally recommended.

Menopause

When it comes to the menopause and migraines, it’s unfortunately usually a case of things getting worse before they get better. With fluctuating hormone levels in the lead up to the menopause , migraine sufferers can find that their attacks get more severe and frequent.
But when oestrogen levels stabilise after the menopause, women usually find that their migraines aren’t as bad. Women who suffer from menstrual migraines obviously find that they disappear completely after the menopause!

The jury is still out on the effects of hormone replacement therapy (HRT) on migraines- like the Pill, it can depend on the hormone balance in an individual. However, it seems that migraine is more likely to worsen with oral HRT and improve with non-oral HRT such as patches and gels.

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This article on Migraines is written by Lisa Jewell, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national journals, newsletters and web sites.