An estimated 25 million women in this country suffer from migraines. Women in their childbearing years are those most affected.
Estrogen appears to be the critical hormone involved in triggering migraines in susceptible women. It is the drop in estrogen level that appears to be significant. This is based, in part, on the following observations.
- Women are 4-5 times more likely than men to suffer from migraines.
- It is known that estrogen levels increase at ovulation and then drop sharply prior to menstruation, a time when many migraine sufferers are at greatest risk for having a migraine.
- During a cycle of taking oral contraceptives medication, the greatest risk for migraine is during the medication-free part of the cycle.
- Migraine headaches are often improved during pregnancy, particularly in the second trimester when hormonal stability is present.
Hormonal manipulations have been attempted to control hormonally related migraines. During menopause, estrogen replacement therapy may be effective. In treating menstrual migraines, however, estrogen pills or patches have generally shown to not be helpful. This may be because of variations in absorption and metabolism.
More recently, treatment of menstrual migraines with anti-estrogen therapies has shown effectiveness. Surgical removal of the ovaries can be helpful, but medications are now being used in place of this. Medications such as Danazol, Tamoxifen, and Lupron have helped some women with this problem.
Hormonally-related migraines are often especially difficult to treat effectively. Usually we start with an "as needed" medication such as an over-the-counter analgesic, Midrin, Cafergot, Imitrex, or Migranal. These come in various forms, including pills, nasal sprays and injections. For someone with frequent headaches, a daily prophylactic medication is prescribed. These are generally from one of three types of medications: antihypertensives (e.g. Inderal, Verapamil), anti-epileptics (e.g. Depakote, Neurontin), and antidepressants (e.g. Elavil, Prozac).
Hormonal manipulation may be necessary if the above treatments do not help. Depending on circumstances, this may involve changing the estrogen dose or mode of delivery, changing or discontinuing oral contraceptives, and the anti-estrogen medications Danazol, Tamoxifen, and Lupron.
Even though the newer treatments have helped many women, unfortunately not all women with hormonally related migraines will respond to current therapies. Migraine treatment options have increased significantly over the last few years, and most likely will continue to improve.
Dr. Bruce Katuna is a board certified neurologist. He joined the staff of Longmont Clinic in September 1990.