Migraine headaches are more common in women and
60-70% of women with migraines report some relationship
with their menstrual period. Usually there is an increased
frequency before, during and after menses. There is
a category of migraine that is called a true menstrual
migraine. This is a migraine headache that occurs
regularly, each month but only between the 2nd day
before the menses and the end of menstruation. Menstrual
migraine is thought to occur in about 14% of women.
The reason it is important to diagnose this subcategory
of migraine is because it seems to be triggered by
falling estrogen (estradiol) levels at the end of
the menstrual cycle. Therefore it is quite treatable
with low doses of estrogen starting one to two days
before menses and continuing throughout the menstrual
flow. Menstrual migraine can also be a problem on
birth control pills. In this case, the migraine occurs
in the seven days off of the active pills (during
the seven different colored inactive sugar or iron
pills). This can also be treated with low dose estrogen
during that seven days.
Sometimes, what is a migraine headache versus what
is just a chronic tension-type headache gets confused.
A recent publication, Ling FW et al (eds.): Strategies
for the management of headache. Association of Professors
of Gynecology and Obstetrics Educational Series on
Women's Health Issues. 1998, had a good discussion
of the different types of headaches in women. They
organized the International Headache Society classification
of headaches:
Headache Diagnostic Criteria
Migraine without aura Migraine with aura Chronic tension-type
At least 5 attacks fulfilling the following criteria:
At least 2 attacks having at least 3 of the following
characteristics: --
headache lasts 4-72 hours if untreated one or more
aura symptoms occur and are fully reversible average
frequency of 15 days per month for 6 months
headache includes at least two of the following characterisitcs
-- unilateral location, pulsating quality, moderate
to severe intensity which inhibits or prohibits daily
activity, aggravation by routine physical activity
at least one aura symptom develops gradually over
more than 4 minutes or 2 or more symptoms occur in
succession. at least 2 of the following pain characteristics:
pressing or tightening, mild or moderate severity,
bilateral location, not aggravated by physicial activity
headache is accompanied by at least one of the following
-- nausea and/or vomitting, light or sound sensitivity
no single aura symptom lasts more than 60 minutes
no vomiting
-- headache begins just before or within 60 minutes
of an aura nausea, light or sound sensitivity
Plus
other disease/disorder process is ruled out or if
present, migraine attacks do not occur for the first
time in close temporal relation to the disease/disorder
secondary cause excluded by a medical evaluation --
Almost one in six women are thought to suffer from
migraine headaches with a peak incidence between ages
25 and 55. Of those women only about 40% have been
diagnosed by a physician.
Aura symptoms
visual flashing lights, bright zig-zag patterns or
blind spots
loss of balance
change or loss in level of consciousness
double vision
ringing in ears or hearing loss
dizziness
difficulty moving
bilateral weakness or nerve feeling disturbance
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