Medicineworld.org: Migraine Prevention In Women
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Migraine Prevention In Women
To better understand this issue and provide guidance for physicians treating female migraine patients, Mayo Clinic in Arizona Women's Health Internal Medicine physicians evaluated all the major studies on the disorder reported in the past five years. They compiled study results into a concise review for clinicians, reported in the August 2006 issue of the Mayo Clinic Proceedings.
"Most people with migraines first seek help from their primary care provider instead of a neurologist or a specialist. The purpose of our paper is to provide more information for primary care physicians who typically manage these cases," says Beverly Tozer, M.D., who led the review.
The review emphasized preventive therapies for migraines at different stages of a female's life. As per Dr. Tozer, good evidence suggests that hormonal changes effect migraine development, with migraines being most prevalent during the reproductive years.
"Almost one-fourth of women in their reproductive years experience migraines," Dr. Tozer says. "During these years, women are building both their families and their careers. The predominance of this disorder in women with its associated social, functional and economic consequences makes migraine an important issue in women's health".
Approaching the issue with regard to hormonal causes, the Mayo authors tracked migraine development and therapy for women from childhood to menopause.
Childhood and Adolescence:
Research observed that in children ages 4 to 7, girls are less likely than boys to have migraines. However, by puberty, girls are three times more likely than boys to have migraines. Stress is a major migraine trigger for children and adolescents, and stress management techniques have helped children as young as 8 years.
If other therapies and changes in lifestyle fail to reduce migraines, scientists have observed that cyproheptadine is a useful medicine for children under 6, with several other preventive medications available to older children. As a number of as one-third of all pediatric migraine patients require periodic courses of daily preventive medication.
Menstrual migraine -- Migraines increase substantially after menarche. Menstruation is one of the most common migraine triggers. Menstrual migraines are typically migraines without aura (bright flashing lights that may precede migraine) that occur predictably around the menses. They are caused, studies suggest, by the decline in estrogen levels before menstruation. Menstrual migraines may be prevented by taking medicine only during the vulnerable period when migraines are expected to occur.
Medications used in the prevention of menstrual migraine include nonsteroidal anti-inflammatory drugs, ergots, alkaloids and triptans. Medications used in the prevention of other migraines also are effective in preventing menstrual migraine. In some patients, menstrual migraines also may be managed with hormonal manipulation using oral contraceptives. However, reviewers emphasized that oral contraceptives should not be prescribed in migraine patients who smoke because of the dramatic increased risk of stroke.
Pregnancy -- Pregnant women with migraines often have fewer attacks by the end of the first trimester. As per the studies, 50 percent to 80 percent of women noted a decrease in attacks, while a smaller percentage experienced a worsening or onset of attacks. The reviewers noted that pregnant women should avoid using medicine except in severe cases.
If it is determined that the benefits of the preventive treatment outweigh the risks to both mother and fetus, medications such as propranolol hydrochloride, verapamil hydrochloride and topiramate may be used. However, valproic acid, divalproex sodium and ergot derivatives should never be prescribed to pregnant patients.
Early menopause -- Changing hormone levels make the menopausal transition challenging for a number of women with migraines. Studies observed that hormonal manipulation and long cycle usage of low-dose oral contraceptives have been useful in managing these migraines.
Late menopause -- Migraines beginning after age 65 is extremely uncommon and warrants further evaluation. Physicians should be aware that as a number of as one-third of all headaches in elderly women are due to secondary causes. Doctors recommend lower doses of all preventive medicine for this group to avoid side-effects. Medication also should be selected with consideration to other health conditions.
Posted by: Daniel Source
Did you know?
Migraines are more common in the United States than diabetes, osteoarthritis or asthma. Of the 28 million people who experience migraines in this country, 18 million are women. Eventhough prevention is very effective in managing this disorder, only 3 percent to 5 percent of women seek preventive treatment.
Medicineworld.org: Migraine Prevention In Women
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