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MIGRAINE HEADACHE IN WOMEN

Timothy C. Hain, MD, Chicago IL. Return to Migraine main page. Page last modified: December 26, 2007

You may also be interested in our many other pages on migraine on this site

Migraines are recurrent headaches separated by symptom-free intervals and accompanied by nausea and light sensitivity. Migraines are often accompanied by visual symptoms and are relieved by sleep; furthermore there is usually a throbbing quality.

Women have more migraine 3 times more commonly than men because of hormonal fluctuations. There is reasonable evidence that the increased incidence of migraines is caused by going from a high to a low estrogen state (Somerville, 1975; MacGregor et al, 2007). Boys and girls prior to puberty have equal rates. Several special considerations apply to women.

Hormones: In women with migraine, birth control pills should be stopped and hormonal supplementation should be stopped. If hormones cannot be stopped, say because of endometriosis, then they should be changed to a constant amount every day. It often takes 2-3 months for the beneficial effects of hormonal manipulations to take effect.

Lupron "cycling" therapy, often aggravates migraine, and if practical considering the entire health picture, it should be stopped.

Menstrual migraine

Increased headaches around menses are due to fluctuations in estrogen level (a withdrawal effect). Medications include:

Prophylactic medications:

Abortive medications

Pregnancy and Migraine

Migraine often (77%) improves during pregnancy, especially in the 2nd and 3rd trimester (Sances et al, 2003).  Most clinicians advise avoidance of medication when at all possible, using instead dietary modification, ice, or simply rest.

If medications are deemed necessary, it is generally felt that no migraine specific medications (like "ergots") should be used during pregnancy because of the danger of inducing early labor. Nevertheless, a recent report suggested that there is no difference in pregnancy outcome when sumatriptan is used in the first trimester (Shuhaiber et al, 1998). Preventive medications cannot be used until the third trimester. Then some clinicians use amitriptyline or imipramine as both have a long record of safety during pregnancy. These should be withdrawn 2 weeks prior to estimated date of delivery. Inderal (propranolol) may reduce cardiac performance during delivery, and should be avoided if possible for this reason.

For pain, one may use acetaminophen (tylenol). Birth defects have not been attributed to acetaminophen after almost four decades of use worldwide. Aspirin and non-steroidal anti-inflammatory should be avoided in pregnancy (because of bleeding potential

 

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© Copyright May 22, 2008 , Timothy C. Hain, M.D. All rights reserved. Last saved on May 22, 2008