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UC busts a big migraine myth

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Posted at 8:00 AM, Mar 01, 2016
and last updated 2016-03-01 14:59:28-05

CINCINNATI -- A recent study suggests increased migraines tend to be a bigger headache for aging women than previously believed.

Research conducted by the UC Neuroscience Institute, Montefiore Headache Center, Albert Einstein College of Medicine and Vedanta Research revealed a 60 to 70 percent increase in high-frequency headaches among women both approaching and in menopause who already experienced migraines. Findings were just published online in “Headache: The Journal of Head and Face Pain,” a publication of the American Headache Society.

According to study lead author Vincent Martin, University of Cincinnati professor of internal medicine and co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute, findings contradict current health beliefs that suggest migraines in women decrease during menopause. About 27 million, or 18 percent, of women in the U.S. suffer from migraines.

“The fact we believe migraines always improve with menopause is a myth,” he said. “For years, women with migraines have been telling doctors that their headaches get worse during perimenopause, but to date, we really haven’t had any medical evidence to suggest that is truly the case. This is the very first study to suggest the frequency of headache at least in a sub-group of women may actually worsen during the perimenopause and menopausal time periods.”

The study identified a sharp migraine increase in a sub-group of participants during the perimenopause phase, when women just start noticing change in their cycles with increased or decreased frequency or bleeding. In these women, he said, the cause may primarily be changing estrogen levels. He said that introducing low doses of hormones via patches or birth control pills often helps decrease migraine frequency.

“There are some women whose migraines dramatically worsen when the estrogen levels are particularly low, and when you add those hormones back it can make a tremendous difference in their headaches,” he said. “But there is a risk for menopausal replacement therapy in women for breast cancer, heart disease and stroke, so the doctor has to weigh the risk versus the benefits.”

A second option, Martin said, is to treat migraines using current preventative medications such as Topamax or amitriptyline, which blunts the response of the nervous system to the hormones.

“So it comes down to either treating the cause or treat the effects,” he said.

For woman in late stages of menopause where they’ve primarily quit cycling, he said, the risk for headache became most apparent. While estrogen and progesterone loss are identified as a primary cause in this group, he said, findings also suggested these women may be introducing an additional trigger inadvertently. Martin said the increased use of pain medications taken for conditions like osteoarthritis may actually be responsible for bringing on migraines.

“Women, as they get older, develop lots of aches and pains, joints and back pain, and it is possible their overuse of pain medications for headache and other conditions might actually drive an increase in headaches for the menopause group,” he said.

People with “high-frequency headaches” are defined as those experiencing migraines more than 10 days per month, Martin said. Migraines rank in the top 10 causes for disability worldwide, he said, leading to people missing work or suffering from presentism, a condition defined as a person physically at work but only functioning at about 30 percent capacity.

“That means that the person is present, but they’re not really present,” he said. “I’ve seen people get divorced because of migraines, I’ve seen people lose their jobs because of migraines – so it has a huge impact on that individual’s life.”

Martin noted there is a distinct difference between migraines and tension headache syndromes:

Tension headaches

  • Mild to moderate in nature
  • Occurs on both sides of head
  • Primary symptom headache
  • Treat with over-the-counter pain reliever

Migraine headaches

  • Moderate to severe in nature
  • Occurs on one side of headache about two-thirds of the time
  • Head throbbing, nausea, dizziness, sensitivity to light and noise
  • People often seek medical attention

Migraine Facts (from Migraine Research Foundation):

  • Nearly 1 in 4 U.S. households includes someone with migraine.
  • About 18 percent of American women and 6 percent of men suffer from migraine.
  • Migraine tends to run in families. If one parent suffers from migraine, there is a 40 percent chance a child will suffer. If both parents suffer, the chance rises to 90 percent.
  • Migraine is the eighth-most disabling illness in the world.
  • Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine.
  • While most sufferers experience attacks once or twice a month, 14 million people, about 4 percent, have chronic daily headache, when attacks occur at least 15 days per month.
  • More than 90 percent of sufferers are unable to work or function normally during their migraine.