Migraine is a neurological disease that appears as a moderate to severe headache and is associated with other symptoms such as nausea, vomiting, sensitivity to light and sound, and difficulty concentrating.
In Spain it affects more than five million people, of which 70% suffer a severe disability and 14% moderate, according to data from the Spanish Society of Neurology (SEN). The same data also tell us that the 80% of people are women.
Although migraines are not life-threatening, they can negatively affect quality of life as a disabling neurological disease. So much so that the World Health Organization (WHO) has identified it as the sixth highest cause worldwide of “years lost due to disability”.
What Causes Migraines
Although the exact cause of migraines is not known, some research suggests that the answer may lie in the genetics because they tend to be hereditary, although this does not mean that all family members suffer from it. Several different genes have to step in and combine for this to happen.
Some migraine sufferers experience “aura,” a series of sensory disturbances, such as flashes of light, dots, or tingling and numbness in the hands and face.
It is also known, as we have seen, that women have three times more likely than men of suffering from migraines. In this case, the most likely culprits for this are a woman’s hormonal fluctuations throughout her life (in addition to some medical conditions).
Does this fact explain that there may be a connection between hormones and migraines?
Migraine, women and hormones, a connected circle
Although the exact reasons why women are more likely than men to have migraines are not exactly known, it is established that fluctuating hormone levels play an important role.
Estrogens regulate the female reproductive system and also control chemicals in the brain that affect pain sensation. A drop in the levels of these estrogens can cause a headache, in most cases in the form of a migraine.
Estrogen is also known to have an impact on the action of serotonin, a neurotransmitter that modulates pain and mood. Estrogen also affects blood vessels and blood pressure. Blood vessel disorders are also known to play a role in migraines. Both factors could mediate the connection between estrogen and migraine.
Life stages and migraines
“After puberty, the frequency of migraines multiplies by three in women”, acknowledges Dr. Alex Jaimes Sánchez, specialist of the Neurology Service and the Headache Unit of the Jiménez Díaz Foundation and contributor to the blog of this unit, CefaBlog.
Many women living with migraine have it more often before, after, or during the menstrual cycle. The peculiarity of this type of migraine is that they are usually more intense than the other crises, hence treating them is a bit more complex. According to the specialist, it is advisable to carry out a short five-day preventive treatment starting two days before the rule.
Another factor associated with the appearance of migraine in women are the contraceptives hormonal since those that include estrogens can trigger more migraine attacks. Additionally, migraine with aura in women under 50 has been shown to be associated with a slightly increased risk of ischemic stroke, especially if they also smoke and use oral contraceptives, according to research published in The British Medical Journal. In these cases, it is advisable to use barrier contraceptives or only with progestogens (pills, subdermal implant, depot injection, IUD).
The good news is that in the case of migraine without aura, some women not only do not experience a worsening of attacks with estrogen contraceptives, but may even notice an improvement.
The pregnancy It is another of the key stages in which a worsening usually occurs, especially during the first trimester, which is when the level of estrogen increases rapidly. But it improves during the second and third trimesters. The challenge is to treat migraine during pregnancy due to the maternal-fetal risk. As Jaimes recognizes, it is advisable to use paracetamol associated with metoclopramide. In general, the use of triptans (rizatriptan, electriptan, etc.) is not recommended, on the other hand, because current studies are not conclusive, nor of non-steroidal anti-inflammatory drugs (NSAIDs) due to their possible adverse effects.
Other measures away from drugs are to lead a regular lifestyle of sleep and meals and exercise whenever it is not contraindicated. In the event that the migraine is accentuated during the lactationYes, ibuprofen can be used because the body eliminates it relatively quickly.