Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, January 21, 1992 TAG: 9201210227
SECTION: EXTRA PAGE: E-6 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Long
HORMONE CHANGES BRING ON MIGRAINES FOR WOMEN
Before puberty, migraine headaches afflict boys and girls in equal numbers. But once the adolescent flow of sex hormones begins, migraines start to affect more girls than boys. By adulthood, at least twice as many women as men are plagued with these life-disrupting headaches, which make them feel sick all over.For decades, people have tried to account for this difference. Many lay people and professionals alike mistakenly attributed it to traits like perfectionism or nervous anxiety, to sexual conflicts or to deep-seated emotional problems that they believed were more characteristic of women than of men.
But in recent years as the neurochemistry of sex hormones and migraines has come to be better understood, a rather clear-cut biological explanation for this all-too-common affliction of women has emerged.
In at least 60 percent of women with migraines, their headaches are often or solely set off by changing levels of sex hormones that are either produced naturally or administered as medication or for contraception.
The headache typically occurs at or just before the start of menstrual bleeding and sometimes midway through the period or, more often, at the time of ovulation.
Recent studies strongly suggest that the headaches and the symptoms of nausea, mood disturbance and ultrasensitivity to light and noise that often accompany them stem from an abrupt drop in previously high levels of estrogen.
Women who suffer from the syndrome, called menstrual migraine, also often complain of such menstrual discomforts as fluid retention and breast tenderness.
"Women are not imagining these headaches, and they are not a psychiatric or psychosomatic phenomenon," said Dr. Stephen Silberstein, a neurologist at the Comprehensive Headache Center at Germantown Hospital in Philadelphia. "The headaches result from real biochemical changes in the brain."
Unfortunately, he added, "most physicians and even most neurologists are not aware of menstrual migraine and what can be done to prevent or treat it."
Women are most likely to begin having migraine headaches in their teen-age years, and fully one-third of women with menstrual migraine got their first headaches with their first menstrual periods.
For approximately one woman in seven with migraine, the headaches occur only in relation to their menstrual cycles or treatment with sex hormones. They may not always get a migraine at the time of menstruation, but when they do, it is always set off by a shift in hormone levels.
But in the majority of women with menstrual migraine, the headaches can also be caused by other factors, like a food, alcohol, irregular eating or sleeping habits or excessive stress.
A particular trigger, like alcohol, may not always result in a migraine, Silberstein said, but when it is combined with the normal premenstrual or mid-cycle hormonal shift, migraine is a common result in susceptible women.
In most women with menstrual migraine, the headaches disappear in pregnancy, when blood levels of estrogen are continuously high until the baby is born. Menopause can bring an end to the headaches, though they sometimes get worse after a woman stops menstruating.
The use of oral contraceptives containing estrogens taken for only part of the month can set off or aggravate menstrual migraine. Postmenopausal treatment with replacement hormones may also make the headaches worse.
Estrogens affect the action of serotonin, an important neurochemical that affects moods, acts on cells in the brain's vomiting center and can cause inflammation of blood vessels and membranes in the skull. During a migraine headache, Silberstein said, cell receptors for serotonin are turned on, allowing this neurochemical to work overtime.
Serotonin also affects the production of endorphins, which are natural narcotics. In menstrual migraine women may have a deficiency of endorphins, suggesting that the headache or some of its symptoms may result from withdrawal of internally produced narcotics.
Hormone-like chemicals called prostaglandins are also active during menstrual migraine. Women prone to these headaches seem to have more than the usual amount of prostaglandins in their uterus and blood.
The actions of prostaglandins include an increase in the sensitivity of the nervous system to sensations like pain, light and noise, so that stimuli not usually bothersome can become extremely painful.
Start by keeping a headache diary. Each time a headache starts, record all possible aggravating circumstances, including foods and drinks consumed, changes in your usual sleeping and eating habits, rises in stress and stage in your menstrual cycle. After a few months examine the diary for reasonable associations.
You may find no relation to anything other than the stage of your menstrual cycle. Or you may find that your headaches often follow the consumption of alcohol, but only when you drink alcohol just before your period or mid-cycle, when you ovulate.
Other common trigger foods include cheese, chocolate and red (but not white) wine. Staying up unusually late or skipping meals may also be triggers at certain times of the month.
- The New York Times
Jane E. Brody writes about health issues for The New York Times.