If you suffer from migraines during pregnancy, you’re not alone—millions of women are faced with these debilitating headaches each year. Learn what triggers migraines, what your hormones have to do with them, and how you can get relief.
“You kids are giving me a migraine!” Ever heard that one? If you grew up in my house, you got to hear my mom mutter that phrase under her breath or yell it at the top of her lungs about once a week. Although my mother had her hands full raising four kids, the good news is that she really never did suffer from actual migraine headaches. The bad news is that nearly 32 million Americans, most of whom are women, are regularly debilitated by the serious health condition known today as Migraine Disease.
What Is a Migraine?
Comparing a headache to a migraine is like comparing a bee sting to a bullet wound,” proclaims Anne Fleming, 32, who experienced her first migraine in her mid-teens. Sufferers generally experience intense, throbbing pain on one side of the head that renders them unable to function, unlike typical headaches that manifest themselves in constant pain on both sides.
Migraines can last anywhere from a few hours to several days and are often accompanied by nausea and sensitivity to light and noise. A small number of people experience strange symptoms called auras that include visual disturbances, such as black dots or wavy lines, light flashes, vision loss, or numbness on one side of the body.
According to the American Migraine Prevalence and Prevention Study (AMPP), “Nine out of 10 sufferers report they can’t ‘function normally’ during days in which a migraine strikes, and nearly three in 10 require bed rest. More than 25 percent missed at least one day of work over the past three months due to a migraine, and almost 50 percent report their migraines prevented them from doing household chores.”
Who Gets Them?
An estimated 29.5 million Americans suffer from migraines, and an astounding 80 percent of those are women. MAGNUM, a national migraine awareness and education group, reports that, “Approximately 1 in 5 women gets migraines, while only 1 in 16 men get migraines.” Dr. Steven Singer, founder of Neurological Associates of Washington and the Northwest Headache Clinic in Kirkland, Washington, puts it bluntly, “Men are a blip on the mountain of migraines.”
People with parents who had migraines have a 50 percent higher likelihood of succumbing to them, so genetics certainly play a role in this disease. Interestingly, the number of young boys and girls who are treated for migraines is nearly equal until puberty, but once girls reach menarche (the first menstrual period), the frequency in migraines rises dramatically for women and subsequently drops significantly after menopause.
What Causes Migraines?
While the precise cause of migraines isn’t completely understood, doctors do know that the nerve endings in the brain are overexcited and inflamed during attacks; that’s why most migraine specialists are neurologists—physicians who specialize in the nervous system. What they do know is that most of these episodes are brought on by triggers that include sudden changes in the weather, fluorescent lights, caffeine, stress, alcohol, and menstruation. Migraine triggers are unique to each patient, and many people react to a combination of them.
While sufferers who know that their disease is triggered by foods containing MSG, caffeine, or aspartame can take steps to avoid these chemicals, many patients are stricken by migraines by forces beyond their control. The National Headache Foundation recently surveyed 305 migraine sufferers and discovered that 85 percent of them cited environmental causes as a trigger. In fact, Germany has a toll-free hotline that migraineurs can call to determine if approaching weather patterns put them at risk for an attack.
Another virtually uncontrollable trigger is menstruation. The vast majority of migraineurs are women and approximately 60 percent of them report menstrual-related migraines. Add in the fact that migraine attacks occur most frequently between the ages of 15 and 55, a woman’s most fertile years, and that makes Migraine Disease not only a women’s health issue, but a mother’s health issue.
Dr. Patrick Lavin, MB, BCh, BAO, MRCPI, Professor of Neurology and Ophthalmology and the Director of the Headache Clinic at Vanderbilt University, explains, “The fall in estrogen just before a period can precipitate a migraine. There is also a drop in estrogen mid-cycle, just before ovulation,” that can also bring on an attack. Lavin says, “Female patients often find relief during pregnancy when hormone levels are steady and high.”
Some women prevent migraines by taking low-dose birth control pills for several months at a time to avoid having more than four periods a year, but that method doesn’t work for everyone. If a person experiences migraines with auras (tingling, strange smells, or odd changes in vision), it puts them at an increased risk for potentially deadly strokes. Since oral contraceptives also increase stroke risk, they might not be the right migraine preventative measure.
A small percentage of women undergo drastic procedures such as endometrial ablation, removing the uterine lining that causes monthly bleeding, or complete hysterectomies to remove the uterus and ovaries in an attempt to escape the crippling pain of migraines. Dr. Lavin recommends that anyone who suspects she is suffering from this disease should meet with a headache specialist to determine her best course of prevention and treatment.
The Role of Stress
Although stress is often the culprit in tension headaches, Lavin says, “Stress can certainly precipitate migraines.” Since women are most likely to get migraines between the ages of 15 and 55, and that’s also the time in their lives when they are juggling careers, children, and marriage, the role of stress cannot be ignored.
The stress-migraine link is further supported by a 1999 article in the journal Headache. In the report, Dr. Randolph W. Evans of the University of Texas at Houston described migraine patients who linked their headaches to crying. Nothing happened when they cried from happiness, cutting onions, or in response to a movie, but tears of sadness or frustration inevitably led to a migraine attack. Many stress-induced migraine sufferers report relief by changing jobs, committing to a regular exercise regimen, establishing regular bedtimes, and practicing yoga or meditation—all proven methods of stress reduction.
In addition to reducing stress, there are two paths to migraine treatment, prevention and pain relief, and most people employ both techniques. One form of prevention is to simply avoid migraine triggers whenever possible. For some people, that means cutting red meat, chocolate, and coffee from their diets. Others avoid flying in airplanes because their migraines are triggered by drastic changes in altitude and barometric pressure. Migraineurs can also take preventative medications like Topiramate and Depakote—drugs that are also used to treat epileptic seizures and depression.
Just as each patient reacts to unique migraine triggers, individuals respond differently to a variety of headache treatments. Lavin says, “Aspirin works for some people. For other people you need more potent medications.” Most doctors recommend patients try over-the-counter remedies such as Ibuprofen and acetaminophen first, but those don’t always help. Some people react well to drugs known as ergotamines which constrict the blood vessels in the brain and reduce a migraine’s signature throbbing pain.
A new class of drugs called triptans came on the scene about 12 years ago to the relief of many migraineurs. Triptans, marketed under names like Imitrex and Zomig and only available by prescription, also constrict blood vessels, as well as behave like the chemical serotonin to calm inflamed nerve endings in the brain, effectively halting an attack before it can run its course. Triptans work so well for some people, that instead of being sidelined for hours or days by a migraine, they are up and back to work in as little as an hour.
Don’t Suffer in Silence
A migraine isn’t just a “bad headache.” It’s a debilitating neurological condition that results in an estimated annual 155 million lost workdays in just the United States. It is imperative that migraine sufferers consult with a specialist to determine with best course of prevention and treatment, not only to prevent attacks, but to identify possible stroke risks and analyze potential drug interactions. Since each migraine is unique to the person that experiences it, a physician can help tailor a plan of action to ensure that patients aren’t missing out on life because of their condition. In the meantime, scientists are working to discover the genetics of migraines: “There are some clues. They are studying it,” Lavin says, so that perhaps someday, migraines will be a thing of the past.
American Council for Headache Education (ACHE)
Phone: (856) 423-0258
Internet Address: http://www.achenet.org
American Headache Society
Phone Number: (856) 423-0043
Internet Address: http://ahsnet.org
Migraine Awareness Group: A National Understanding For Migraineurs
Phone Number: (703) 739-9384
Internet Address: http://www.migraines.org
National Headache Foundation
Phone Number: (888) 643-5552
Internet Address: http://www.headaches.org