MIGRAINE IN WOMEN
Migraine affects women differently from men. Attacks in women last slightly longer than in men, though this difference only becomes apparent after puberty, when oestrogen levels have started to rise.
In eighty per cent of cases, migraine improves dining pregnancy, but it can also worsen. Those who have had menstrual migraine tend to lose it during pregnancy because of the raised (and more constant) levels of oestrogen. It is also common for a migraine to occur around the fourth to sixth day after delivery, when the oestrogen levels drop after childbirth.
The level of attacks may also improve at the menopause, when oestrogen levels drop. However, although some women experience a decline in their migraine at this time, others find that this is when their symptoms start or get much worse. Sometimes migraine at the time of the menopause can be helped with hormone replacement therapy (HRT) which provides extra oestrogen. Pizotifen is a non-hormonal drug that can also be used.
About ten to fifteen per cent of women experience migraine occurring at the time of the period. This also responds to extra oestrogen, perhaps as a ‘patch’ stuck on to the skin. Just to confuse matters, the Pill (which contains oestrogen and progesterone) can make established migraine worse, or even cause an aura to appear where previously the attacks were without one. Remember: if you get a migraine for the first time on the Pill, discontinue taking it immediately, and contact your doctor.
Occasionally patients find that their migraines occur when they are ovulating, in the middle of the cycle. Finally, and very interestingly, there seems to be no great alteration in migraine patterns alter hysterectomy or removal of the ovaries.
In other words, some migraines seem to be related to oestrogen. It must be remembered that oestrogen is not the only female hormone. Progesterone is also a major part of the female hormone cycle and there be other could links which we have not yet discovered. It may well be that the relationship between hormones and migraines in women is much more subtle, being affected by a relative balance of a group of hormones rather than the effects of a single hormone on its own.
Finally the trigger effects of oestrogen can combine with other triggering events. In other words, the effects of a missing meal may be much worse during your period; the triggering of the drop in blood sugar combines with the triggering effect of a drop in oestrogen often causing a migraine.
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