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The down & dirty on women's wellness


Headache

What a Headache!

June 1, 2020

Of the more than 39 million American sufferers, 28 million are women. Migraine is one of the leading serious health problems that disproportionately affects women. Women suffer from migraine three times as often as men. In the U.S., 18% of women suffer compared to 6% of men. But during the reproductive years, as many as 43% of women suffer. Of those who suffer, 50% have more than 1 attack each month, & 25% have 4 or more severe attacks per month. 85% of chronic migraine sufferers are women. 92% of women with severe migraine are disabled.


The difference in migraine headache prevalence & presentation in women as compared to men is often attributed to differences in hormones &, in particular, the fluctuant nature of hormones in women’s bodies. Unlike men, who are biologically programmed in ways that do not require them to dramatically cycle throughout the month, women are affected by sudden increases or decreases in luteinizing hormone, follicle stimulating hormone, estrogen & progesterone in rapid succession throughout each month. Not only are migraine headaches more common in women, but they are also harder to treat, & we can blame this on estrogen. Estrogen regulates the female reproductive system, & it also happens to control chemicals in the brain that impact the sensation of pain. A drop in estrogen levels can cause a headache, typically in the form of a migraine, that lasts anywhere from four to 72 hours.


In addition to having more migraine headaches more often than men, women experience migraine differently than do men. Women report episodic pain (often for a longer duration) & chronic pain more frequently than men. Women who experience more severe & more frequent migraine attacks often have dramatic changes in estrogen levels. Research has consistently connected hormones to migraine, but not all migraines are hormonal.


It is important for women who suffer from recurrent headaches to keep careful track of the nature of the headaches, including when the occur (especially relative to her menstrual period), how long they last, what activities preceded them, how much sleep they got, which medications they took, which treatments failed & which offered relief, & what they had been recently eating & drinking. Each of these things can shed light on the potential source of the headaches & offer options for prevention &/or treatment. 


Sometimes, things that provoke migraine headaches can be surprising, & sometimes they can be difficult to identify because the inciting factors may not be readily apparent. This is part of why it is so essential for female headache sufferers to track their symptoms (& their cycles) diligently. The exact cause of migraine headaches is not fully understood. Most researchers think that migraine attacks result from abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they cause inflammation. This inflammation then causes blood vessels in the brain to swell & press on nearby nerves, causing pain.


Genes also have been linked to migraine. People who get migraines may have abnormal genes that control the functions of certain brain cells & migraine headaches tend to run in families.


Experts do know that people with migraines react to a variety of factors & events, called triggers. These triggers can vary from person to person & don't always lead to migraine. This inconsistency can sometimes cause frustration in tracking potential triggers. A combination of triggers — not a single thing or event — is more likely to result in a headache. A person's response to triggers also can vary from migraine to migraine. Many women with migraine tend to have attacks triggered by:


• Lack of or too much sleep

• Skipped meals

• Bright lights, loud noises, or strong odors

• Hormone changes, including those related to menstruation, ovulation, conception, pregnancy, childbirth, lactation, perimenopause & menopause

• Dehydration

• Underlying inflammatory conditions, such as autoimmune conditions

• Fluctuations in blood pressure, heart rate, or temperature

• Stress & anxiety, or relaxation after a prolonged period of stress (in direct response to the release of stress hormones)

• Weather changes

• Medications (of all kinds—even pain medications can cause headaches as a side effect)

• Alcohol (often certain kinds of red wine)

• Physical activity (overexertion that causes blood vessel swelling OR not being active enough)

• Caffeine (too much or withdrawal)

• Foods that contain nitrates, such as hot dogs and lunch meats

• Injury

• Foods that contain MSG (monosodium glutamate), a flavor enhancer found in fast foods, other food preservatives or coloring agents, artificial flavors, broths, seasonings, & spices

• Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, & Chianti wine

• Aspartame (NutraSweet® and Equal®) or other non-sugar sweeteners


Not all headaches are migraine headaches. Migraine pain is an intense pulsing from deep within your head. This pain can last for days. The headache significantly limits one’s ability to carry out her daily routine. Migraine is throbbing & usually one-sided. People with migraine headaches are often extremely sensitive to light & sound. Nausea & vomiting also usually occur.


Some migraine is preceded by visual disturbances. About one out of five women will experience these symptoms before the headache starts. Known as an aura, it may cause one to see:


• flashing lights

• shimmering lights

• zigzag lines

• stars

• blind spots


Auras can also include tingling on one side of the face or in one arm & trouble speaking, which are symptoms that are also consistent with having a stroke. If a woman is unsure whether she is having a migraine-related aura or is experiencing symptoms that are not her usual experience of migraine headaches, she should be evaluated to ensure she is not suffering a stroke. Migraine sufferers have an increased risk of stroke as a result of the spasms in the blood vessels that can result in clot formation & release, & it is extremely important to differentiate the causes of symptoms & identify a stroke as soon as possible. 


Headaches that occur that do not follow the typical characteristics of migraine headaches may still be migraine headaches, but it is important to identify the type of headache in order to develop an effective plan for prevention & treatment. Other kinds of headaches include: 


• Tension headaches

• Cluster headaches

• Allergy or sinus-related headaches

• Post-traumatic headaches

• Rebound headaches

• Hypertension headaches


There is significant overlap between migraine headaches & other kinds of headaches, both in triggers & in treatment & prevention options. If you are experiencing recurrent headaches, begin your diary & request assistance from a skilled set of eyes to review the diary & initiate a plan of care that can help you reclaim a life previously hindered by headaches.