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Why are migraines more common in women?

Migraine headaches affect three times as many females as males. Mai-Lynn Bui, D.O., a Piedmont neurologist, says this is because of genetics, hormones and environmental factors.

“Research shows there’s a very pivotal role sex hormones play in migraine development,” Dr. Bui says.

Approximately 10 to 20% of women report experiencing their first migraine attack at the start of their menses.

“We understand that estrogen regulates the female reproductive system and controls chemicals in the brain that impact the sensation of pain, such as the pain molecule calcitonin gene-related peptide (CGRP), which we have found to have a large part in the pain pathway of a migraine,” she says. “With men, on the other hand, the hormone testosterone has a more neural-protective role when it comes to pain signals.”

What migraine treatments are available?

Dr. Bui takes a multimodal approach to treating her migraine patients. First, she looks at lifestyle and environmental factors.

“Stress and emotional triggers can feed into the migraine process,” she says. “Optimizing stress and mental health will help with overall migraine prevalence. The more we optimize lifestyle factors, the more we’ll reduce migraine frequency and severity.” 

In addition, many migraine sufferers need medication to alleviate their symptoms. Dr. Bui says treatment options have come a long way in the past 30 years.

Treatment options are divided into two categories:

  • Preventive therapy to reduce the frequency and severity of migraines.

  • Rescue or abortive therapy to stop a migraine once it starts.

Abortive or rescue therapies for migraines

Abortive or rescue therapies can include:

  • Over-the-counter medications like Advil, Tylenol or Excedrin Migraine

  • Triptans, which work on the serotonin receptors involved in the pain pathway of migraines

  • Anti-nausea medications

Preventive therapies for migraines

Preventive therapies are an option for people with frequent or severe headaches. Preventive treatments are given daily or monthly, depending on the treatment. These drugs include:

  • Beta-blockers

  • Antidepressants

  • Anti-seizure medications

  • CGRP inhibitors

“These options allow us to customize a treatment plan for patients,” Dr. Bui says. “For example, if patients happen to have other coexisting comorbidities, such as high blood pressure, we can choose therapies and treat accordingly.”

Other treatments include:

  • Botox injections: “Botox is FDA-approved for chronic migraines,” Dr. Bui says. “It’s injected into different muscles of the face and neck. Once it enters the nerve endings, it blocks the release of pain chemicals involved in the pain transmission process.” This treatment is given approximately every 12 weeks.

  • Occipital nerve block: “What we do is inject numbing medications into the nerves around the head, neck and shoulders, where people often hold tension,” she says. “This lessens pain signals and helps patients relax.”

  • Sphenopalatine ganglion (SPG) block: “This treatment blocks possible pain signals from a large nerve complex in the central region of the face, which can sometimes be a source of headache pain,” Dr. Bui says.

  • Neuromodulation: The FDA has approved several devices to help with migraine symptoms. These devices can be worn on the forehead, neck, arm or head. Each device works slightly differently, but they all deliver electrical pulses to the nerves, which can lessen activity in the central nervous system.  

  • Biofeedback: “This is a nice alternative treatment for migraines,” she says. “Biofeedback is similar to physical therapy, but designed with headache sufferers in mind. During each session, you gain insight into how your body functions, your heart rate and can learn to understand where you may hold muscle tension. Once you’re aware of these factors, you can retrain your brain to use soothing behaviors to minimize the impact of stress before a migraine happens.”

In addition to these options, Dr. Bui says many promising treatments are currently being studied in clinical trials.

How to prevent migraines

If you experience migraines, Dr. Bui recommends keeping a “migraine diary.” Keeping a log of your headaches can help you identify potential triggers so you can avoid them. Record the date of the attack, time of day, duration, warning signs, symptoms you experienced and possible triggers.

The most common triggers to watch for include:

When to see a healthcare provider for migraines

“If headaches start to disrupt your daily life to the point where you can’t function at 100% and start to become very frequent even if occurring up to once a week, have a conversation with your primary care provider,” Dr. Bui says. “They can refer you to a neurologist if needed to rule out secondary causes of headaches and form a treatment plan.”

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