Mi­graines are big­ger headache for women

Fe­males much more likely to ex­pe­ri­ence chronic dis­or­der.

The Palm Beach Post - - MORE OF TODAY’S TOP NEWS - By Mar­lene Cimons Wash­ing­ton Post — WASH­ING­TON POST

Mi­graine can af­flict men, women and chil­dren. But it is not an equal op­por­tu­nity dis­or­der. Of those who suf­fer chronic crip­pling mi­graine at­tacks, the vast ma­jor­ity are women. They are as many as 85 per­cent, ac­cord­ing to the Mi­graine Re­search Foun­da­tion.

“A re­searcher once said that ‘the fe­male­ness of mi­graine is in­escapable,’ “says El­iz­a­beth Loder, as­so­ciate pro­fes­sor of neu­rol­ogy at Har­vard Med­i­cal School and chief of the di­vi­sion of headache and pain at Brigham and Women’s Hos­pi­tal. “It’s true. Mi­graine dis­pro­por­tion­ately af­fects women.”

A mi­graine is much more than just a ter­ri­ble headache. To be sure, mi­graine typ­i­cally in­volves a painful throb­bing headache, most times on one side of the head, some­times both. But it also is an in­ca­pac­i­tat­ing neu­ro­log­i­cal dis­ease with a wide range of symp­toms, in­clud­ing vis­ual dis­tur­bances, nau­sea and vom­it­ing, dizzi­ness, sen­si­tiv­ity to lights, noises, and scents, and — for some — tem­po­rary weak­ness on one side. Episodes can last for hours, some­times even days.

About 25 per­cent of vic­tims also ex­pe­ri­ence “aura,” a col­lec­tion of sen­sory dis­rup­tions, such as flashes of light, blind spots, or tin­gling and numb­ness in the hands and face. More­over, mi­graine with aura in women un­der age 50 in­creases their risk of is­chemic stroke, es­pe­cially if they also smoke and use oral con­tra­cep­tives.

“We don’t have the an­swer for why mi­graines are more com­mon in women than in men, but women are more sus­cep­ti­ble to every pain con­di­tion than men,” says Janine Clay­ton, who di­rects the Of­fice of Re­search on Women’s Health at the Na­tional In­sti­tutes of Health (NIH). “Also, women in pain are not al­ways taken se­ri­ously. Women are per­ceived as ex­ces­sively seek­ing help.”

Cindy McCain, widow of Sen. John McCain, R-Ariz., has spo­ken out about her ex­pe­ri­ences with mi­graine, and the frus­tra­tion of getting doctors to take her de­bil­i­tat­ing headaches se­ri­ously.

“I saw many doctors who wrote me off as just be­ing ‘over­stressed,’ “she said in one in­ter­view. “Their ad­vice was to go home, re­lax and have a glass of wine.”

Since mi­graines af­fect young women and get bet­ter with age, they are most preva­lent dur­ing a time when women are ex­pected to be most pro­duc­tive at home and work. Be­cause the pain is of­ten worse with rou­tine ac­tiv­ity, “peo­ple tend to re­main still, which has ob­vi­ous detri­ments to­wards pro­duc­tiv­ity,” says Mark W. Green, pro­fes­sor of neu­rol­ogy and anes­the­si­ol­ogy and di­rec­tor of the Cen­ter of Headache and Pain Medicine at Mount Si­nai’s Ic­ahn School of Medicine. “They also get light and sound sen­si­tiv­ity, and it is dif­fi­cult to work, or even func­tion, un­der those con­di­tions.”

Boys ex­pe­ri­ence more mi­graine than girls be­fore pu­berty, then the equa­tion changes, with girls and women bear­ing the brunt of mi­graine until af­ter menopause. The dis­or­der then eases for most women.

For this rea­son, most ex­perts be­lieve that women’s fluc­tu­at­ing hor­mones are a ma­jor in­flu­ence, es­pe­cially when es­tro­gen falls around the time a women has her men­strual pe­riod. Most at­tacks oc­cur sev­eral days be­fore or af­ter men­stru­a­tion.

Green thinks es­tro­gen with­drawal is a ma­jor trig­ger.

“Around pe­riod and ovu­la­tion, and just af­ter a de­liv­ery, lev­els drop pre­cip­i­tously, which can be a prob­lem,” he says. “Af­ter menopause, when the lev­els of es­tro­gen re­main low - they don’t fall most women im­prove. Es­tro­gen falls in­crease the ex­citabil­ity of the brain cor­tex. Mi­graine is a con­di­tion where the cere­bral cor­tex is more ‘ex­citable,’ of­ten ge­net­i­cally, so that is one rea­son why.”

One re­cent small study sug­gested that el­e­vated es­tro­gen may be re­lated to mi­graines in men, although the sci­en­tists said ad­di­tional re­search was needed.

A mi­graine can be set off by other trig­gers, in­clud­ing stress, changes in sleep pat­terns, loud noises, bright lights, strong smells, and var­i­ous foods and bev­er­ages — wine and choco­late, among them. McCain would have been ill-served by the early med­i­cal ad­vice she was given, as wine is one of her trig­gers.

“Think of mi­graine as a prob­lem where the thresh­old for an at­tack is low,” Green says. “Trig­gers that might be ir­rel­e­vant to some­one else can be­come a big mi­graine trig­ger. Any­one might get a headache af­ter drink­ing a quart of red wine, but it takes very lit­tle to trig­ger it in some­one with mi­graine.”

Loder agrees. “In my clin­i­cal ex­pe­ri­ence, I hear a lot about strong scents, women who don’t want to walk into a de­part­ment store and be sprayed by some­one try­ing to sell them per­fume,” she says. More­over, “women face chal­lenges dif­fer­ent from men in the work­place and their per­sonal lives, and we know that stress can have a neg­a­tive im­pact on the course of this dis­or­der.”

Most ex­perts agree that mi­graine prob­a­bly re­sults from the brain’s re­ac­tion to a com­plex in­ter­ac­tion among hor­mones, ge­net­ics and en­vi­ron­men­tal fac­tors.

“Mi­graine is not a hor­monal dis­or­der,” says Michael Oshin­sky, pro­gram di­rec­tor of pain and mi­graine at the Na­tional In­sti­tute of Neu­ro­log­i­cal Dis­or­ders and Stroke at NIH. “That’s a mis­take. Think of it as a very di­verse dis­or­der. Each pa­tient has to be di­ag­nosed with her own cri­te­ria.” While he agrees with other ex­perts that hor­mones of­ten play a piv­otal role, “There are likely many dif­fer­ent path­ways not work­ing prop­erly in the brain that lead to an at­tack,” he says. “It’s a dis­or­der of the nerves and the brain.”

Loder points out that many peo­ple with reg­u­lar hor­monal cy­cles do not get mi­graines, “so it’s prob­a­bly mod­u­lated by many other things in the in­ter­nal and ex­ter­nal en­vi­ron­ment,” she says. “Hor­monal in­flu­ences prob­a­bly can af­fect whether cer­tain neu­rons in the brain will be ac­ti­vated or not. It’s a neu­ro­log­i­cal prob­lem.”

Inna Belfer, a neu­rol­o­gist and sci­en­tist in NIH’s Na­tional Cen­ter for Com­ple­men­tary and In­te­gra­tive Health, agrees.

“Mi­graine is an in­trigu­ing con­di­tion, when you think about it,” she says. “You have a group of neu­rons in the brain that for some rea­sons starts fir­ing, then for an­other rea­son stops fir­ing — and that is an episode.”

She knows about mi­graine first­hand, hav­ing suf­fered from the dis­or­der start­ing at age 12. “I would have about four or five a month,” she says. “Some lasted five hours, other times, as long as three days.”

Now that she is past 50, the num­ber of episodes has de­creased to one or two a month. “The sever­ity of the pain is noth­ing like it was,” she says. “I can func­tion. I can work. How­ever, the aura is still there. The nau­sea is still there. I am still light sen­si­tive.”

Also, she still al­ways smells chlo­rine — not from a swim­ming pool, but from tap wa­ter — be­fore an on­set. That’s how she knows an at­tack is com­ing.

Re­search shows that mi­graines tend to run in fam­i­lies. Stud­ies of twins, for ex­am­ple, show “that if one has mi­graines, it’s more likely for the other twin to have them,” Oshin­sky says. Also, re­search sug­gests that mu­ta­tions in cer­tain genes can cause fa­mil­ial hemi­plegic mi­graine, a type of mi­graine that also causes weak­ness or numb­ness on one side of the body.

A sub­stan­tial body of re­search has found women feel greater pain and show more sen­si­tiv­ity to ex­per­i­men­tally in­duced pain (con­trolled pain tests on sub­jects in a lab­o­ra­tory) when com­pared to men, a pos­si­ble rea­son they are more vul­ner­a­ble to mi­graine. “We don’t know ex­actly how the mi­graine brain is dif­fer­ent from the non-mi­graine brain, but I do think that sex spe­cific dif­fer­ences make the fe­male brain more prone to pain than men, and to ex­pe­ri­ence it dif­fer­ently,” Belfer says.

Although there is no cure, pre­scrip­tion and over-the­counter med­i­ca­tions and com­ple­men­tary ap­proaches, such as cer­tain di­etary sup­ple­ments, mas­sage, re­lax­ation tech­niques and biofeed­back, can treat or pre­vent symp­toms. Clin­i­cians also rec­om­mend keep­ing a mi­graine di­ary to fig­ure out one’s trig­gers — then avoid them, if pos­si­ble.

Re­cent re­search also has found that light-sen­si­tive mi­graine suf­fer­ers might ben­e­fit from ex­po­sure to green light, which seems to lessen the sever­ity of headaches com­pared with be­ing in reg­u­lar light.

“A hot wa­ter bot­tle on my head, neck or shoul­ders is al­ways a res­cue for me, while a friend of mine needs ice,” Belfer says. “I told my hus­band if we ever get a new house, I want a green light room.”

For most women, re­lief usu­ally comes with ag­ing. Un­for­tu­nately, the worst mi­graines “hit when women are try­ing to bal­ance and jug­gle a ca­reer with fam­ily MORE DE­TAILS Mi­graine af­fects 1 in every 7 adults glob­ally, ac­cord­ing to the World Health Or­ga­ni­za­tion. In the United States, nearly 40 mil­lion Amer­i­cans suf­fer from them, in­clud­ing 28 mil­lion women and girls. Mi­graine costs the na­tion an es­ti­mated $78 bil­lion per year, with women ac­count­ing for about 80 per­cent of di­rect med­i­cal and lost la­bor costs, ac­cord­ing to a re­cent re­port from the So­ci­ety for Women’s Health Re­search. re­spon­si­bil­i­ties,” Loder says. “Mi­graines im­prove for most women over time, but you never get back those lost work or school years, or that lost time with your fam­ily.”

HEATHER KHAL­IFA / PHILADEL­PHIA INQUIRER

Louis Col­burn (left) sees Dr. Stephen Sil­ber­stein at the Jef­fer­son Hos­pi­tal for Neu­ro­science in Philadel­phia to re­ceive shots to treat his mi­graine headaches. There is no cure for the in­ca­pac­i­tat­ing dis­or­der.

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