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Click on the topic you want to read:Memory may be improved by hormones - but warning for migraineurs
A new study shows that post-menopausal women can get an unexpected improvement in their memory if they get treated with hormones. Scientists from the University of California, Los Angeles (UCLA) say that brain-scans of the women showed a significant increase in blood-flow during the six weeks they were on a standard course of oestrogens against menopausal symptoms, e.g. hot flushes.´I warmly recommend this treatment to all women who have problems with their menopause´, says Dr. Robert A. Greene. ´The benefits are much greater than the drawbacks.´
Dr. Greene says in addition that the course of oestrogens is safe. Blood clots are rare. But, he says, women with lumps in their breasts or migraine caused by hormones, together with women who are allergic to the inactive part of the pills should not take these pills.
Reuters 18. June 1996.
Uploaded 03-03-2005
Menopause and migraine
Women who have suffered from menstruation migraine often find that they get more migraine around the time of menopause, at the same time as their hormonal cycle is becoming less regular. The now-common monthly treatment with hormones after the menopause can worsen migraine in these women. The use of plasters or oestrogen pills that are taken every night and morning are recommended instead, which will lead to fewer swings in the blood´s content of oestrogen.Neurology 1999, 53, 29-33.
Uploaded 18-12-2004
Menstruation migraine is different
Many women already know it; now there are data that support our belief that menstruation migraine is different from the attacks we experience between our periods.87 women kept a diary during 459 attacks withour aura. 231 of the attacks were between periods and 228 were at the same time as menstruation. The attacks during menstruation were on average shorter (16 hours) than those between periods (30 hours).
The women missed work hours especially during those attacks immediately before their period. Medicine to treat the attacks was used by most, especially NSAID; only 26% used triptans. The medicine was less effective on attacks around the time of menstruation compared with attacks between periods. At other times than around the time of menstruation, the women were free of pain within 2 hours of taking the medicine in 33% of cases, but only in 14 - 23% of cases during attacks around the time of menstruation. There was no difference in the attacks and treatment between those women who took estrogens and those who didn´t.
F. Granella, G. Sances, G. Allais, R. E. Nappi, A. Tirelli, C. Benedetto, B. Brundu, F. Facchinetti and G. Nappi, 2004. Characteristics of menstruational and nonmenstruational attacks in women with menstrually related migraine referred to headache centres. Cephalalgia 24, 707-716.
Uploaded 30-10-2005
Women with menstruation migraine lack the chemical TNF-a
For a long time we have known that menstruation migraine is triggered by a rapid fall in the amount of oestrogen in the blood. There have also been reports of a type of menstruation migraine that didn´t ´fit´ with this explanation. Now an American team has shown that about 2/3 of women with menstruation migraine have very low amounts of something called TNF-á in their urine, both when they were experiencing an attack and when they weren´t. Among other things, TNF-á inhibits irritation in e.g. blood vessels. Other migraineurs had a normal amount of this chemical in their urine, regardless of whether or not they were experiencing an attack.The scientists use this result to point out that it is important to differentiate between menstruation migraine and other forms of migraine.
L. Mueller, A. K. Gupta and T. P. Stein, 2001. Deficiency of TNF-á in a subclass of menstrual migraineurs. Headache 41 (2) 129-137.
Uploaded 03-03-2005
Women may be more sensitive around menstruation
The experiment was performed on mice. There was an increase in the amount of galanin (and another neuropeptide) in the trigeminus nerve of mice just before they came into heat (i.e. just before ovulation) compared with its content after ovulation if they did not become pregnant. The effect of galanin is partly to stimulate the desire to eat more fat, but also reduces our experience of pain.The scientists think that it is possible that women may have the same variations in galanin which would mean that they are more sensitive to pain around menstruation.
V. Puri, L. Cui, C. S. Liverman, K. F. Roby, R. M. Klein, K. M. A. Welch and N. E.J. Berman, 2005. Ovarian steroids regulate neuropeptides in the trigeminal ganglion. Neuropeptids 39, 409-417.
Uploaded 21-10-2006
Oestrogen reduces the effect of pain
Two Swedish scientists, Åsa Amandusson and Anders Blomquist, have made a series of experiments on female rats that showed that the hormone oestrogen can reduce their feelings of pain. Oestrogen stimulates some nerves in the spine that can reduce the feeling of pain.This apparently applies to people too, say the two scientists. They therefore recommend that variations in the amount of oestrogen in women can be part of the explanation why women more often than men suffer from migraine and back-pains.
New Scientist 30. November 1996.
Uploaded 03-03-2005
Women at their best age especially have migraine (in USA)
From a large American data set, doctors could count how many people had had a migraine attack within the last 12 months. They found that especially women in their most productive years had attacks. The difference between men and women continued into the oldest groups and the scientists wonder why, since it can hardly be due to oestrogens.A difference between rich and poor also showed up, with the low income groups having more migraine, but it was the better-off (see above) who went more often to the doctor. There was no difference between town- and country-dwellers.
R. B. Lipton, W. F. Stewart, S. Diamond, M. L. Diamond and M. Reed, 2001. Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache 41, 646-657.
Uploaded 03-03-2005
Oestrogen supplement migraine takes 4 – 6 months to go away
As early as 1982 it was known that it takes 4 – 6 months before the effects of oestrogen supplements disappear. It takes that amount of time for the blood platelets to become normal after they have been affected by the high oestrogen-levels, which makes them clump.The following groups are advised to avoid taking hormone supplements because of increased risk of paralysis from blood-vessel constriction:
H. Massiou and E. A. MacGregor, 2000. Evolution and treatment of migraine with oral contraceptives. Cephalalgia 20, 170-174.
Uploaded 14-12-2004
Contraceptive pills and migraine – American recommendations
There is much debate on the connection between contraceptive pills and migraine. The American migraine doctor Elisabeth Loder´s many years experience suggests the following:Migraine without aura:
Women over 35 with family members who have migraine:
E. W. Loder, D. C. Buse and J. R. Golub, 2005. Headache and combination estrogen-progestin oral contraceptives: integrating evidence, guidelines and clinical practice. Headache 45, 224-231.
Uploaded 21-10-2006
Contraceptive pills and migraine
A paper in the prestigious journal Neurology now clearly warns against the use of contraceptive pills by migraineurs who have strong symptoms of aura or who develop them when they start to take contraceptive pills. It is well-known that contraceptive pills worsen women´s migraine, but it is also possible that some migraineurs can feel better if they take contraceptive pills.The same paper also warns that there is an increased risk of stroke for migraineurs with aura who take contraceptive pills. A comment in the journal Headache points out that the risk of a stroke increases from 1.3 per 100 000 healthy users without migraine to 28 per 100 000 migraineur-users, but that the risk is still low.
Neurology 1999,53, 19-25.
Uploaded 18-12-2004
Overweight and migraine
Overweight women in the child-bearing years have increased risk of developing what´s called Pseudotumor Cerebri. That means that they have symptoms that resemble those of a brain tumour, but there is no tumour. They develop increased pressure in their brains and thereby get tinnitus (ringing in the ears), vision disturbances, neck and back-pains and often fluid accumulates in their hands and feet.Even though an overweight woman has all these symptoms, there is no need to avoid becoming pregnant.
Since these symptoms are difficult to treat, women with them often get prescribed large doses of painkillers that can lead to them developing continuous headaches. Headache 2000, 40, 495-497.
Uploaded 03-03-2005
Preparation for artificial insemination triggers extra migraine attacks
If you are a migraineur who is considering artificial insemination, you should know that the treatment may result in extra migraine attacks. 98 childless women who were being prepared for artificial insemination were asked about their migraine. 25 had been migraineurs before being treated and 28 reported migraine attacks during the treatment.The women reported migraine attacks especially during the first phase of treatment, when the body´s natural oestrogen level is being reduced to nothing. Women who became pregnant had fewer migraine attacks during the last phase of treatment than those who did not conceive. Pregnant women had a significantly higher amount of oestrogen in their blood than those who were not successful after egg implantation.
B.-Y. Amir, B. Yaacov, B. Guy, P. Gad, W. Itzhak and I. Gal, 2005. Headaches in women undergoing in vitro fertilization and embryo-transfer treatment. Headache 45, 215-219.
Uploaded 21-10-2006
Oestrogen and migraine
It has been known since 1972 (1) that ca. 10% of all women that start oestrogen supplements develop migraine about six months later.In Denmark, about 700,000 women take oestrogens, either as contraceptive pills (450,000) or against loss of bone material (250,000) (2). That is, 70,000 Danish women may have this type of self inflicted migraine.
Contraceptive oestrogen is mainly used by women of the age between 21 and 33. Up to 25% of this age group among women have had at least one migraine attack within the last 12 months (data from USA, but probably the same in Denmark) (3).
About 1,100,000 Danish women are between 20 and 49 years old. Almost half of them (ca. 450,000) use oestrogen contraception. We know that 10% of those who begin to take oestrogens will develop migraine (that is they did not have it before) so approximately 45,000 women may have migraine because of their oestrogen supplements.
Assuming that the wish to take oestrogens is not influenced by the woman´s experience of migraine, we must also assume that 10% of the 45,000 women who take oestrogen contraception had migraine before they began the treatment, that is ´only´ around 40,000 Danish women suffer from migraine due to their contraceptive oestrogens, while 110,000 women have migraine caused by their normal oestrogen variations.
Some women, it must be said, experience fewer attacks or become migraine free when they begin oestrogen supplements.
Around 250,000 Danish women take oestrogens after menopause. These women would not have oestrogen migraine without the supplements, as their natural oestrogen variations have stopped. This means that 25,000 older Danish women have migraine attacks because they wish to take oestrogen supplements.
A total of around 65,000 Danish women suffer from migraine attacks because of their wish to take oestrogens.
Migraine may also be triggered by other causes than oestrogens. The major trigger is - probably - food items. 5% of men, women and children probably get migraine from something in their food.
We do not have data for how many migraineurs get triggered by e.g. cold, something in the sinuses, stress or other causes, so these migraineurs are lumped with those who get migraine from food.
(1) U. Larsson-Cohn and P. O. Lundberg, 1972. Headache and treatment with oral contraceptives. Acta Neurol Scand 46, 267-278.
(2) Lægemiddelstyrelsens lægemiddelstatistik, Tabel 2.G.2. Antal personer i behandling med receptordinerede kønshormoner, gynækologiske lægemidler og urinvejsmidler (ATC-gruppe G), 1997-2001. Andel kvinder og median alder (1. og 3. kvartil), 2001 (http://www.produktresume.dk/docushare/dscgi/ds.py/Get/File-17001/Tabel_2.G.2.doc)
(3) R. B. Lipton et al. 2001. Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache 41, 646-657.
Uploaded 14-12-2004
Pregnancy and migraine - often fewer attacks
We do not know for sure whether the migraine will change during a pregnancy, but at least we know the probability for changes for the expectant mothers.58 pregnant women with migraine visited a maternaty clinic in Italy for other reasons than their migraine. 2 had migraine with aura, but only few attacks, and they did not experience any changes during their pregnancies.
The remaining 56 women had migraine without aura. 58% of these experienced a clear reduction in their migraine during the first 3 months of their pregnancy, and 83% had fewer attacks during the following three months. Only very few had migraine during the last three months. Women who had hormonal migraine before they became pregnant were more likely to have attacks during the first three months of their pregnancy. After having given birth the new mothers had migraine again. More than half of them had their first attack within one month after giving birth. Mothers of bottle-fed babies had their first attack earlier than mothers who nursed their babies.
G. Sances, F. Granella, R. E. Nappi, A. Fignon, N. Ghiotto, F. Polatti og G. Nappi, 2003. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia 23, 197-205.
Uploaded 31-05-2005
Triptans and the foetus
Migraineurs can also get pregnant - just as well. But that means that a deal of thought must be given to medicine. Many pregnant migraineurs discover that they get fewer attacks but a few get more and most probably experience at least one attack before their pregnancy is over.The doctors´ rule of thumb is that pregnant women must be very parsimonious about taking medicine unless they are completely sure that the medicine does not affect the foetus. But there is also understanding that pregnant migraineurs can be badly affected by attacks.
No controlled studies have been done (prior to august 2004) on the effects of triptans on pregnant women (1), but from data on 34 women who, for one reason or another, had taken triptans even though they were pregnant, there are reasons to believe that triptans may increase the risk of aborting or of reducing the weight of the child at birth (2).
(1) M. L. Hilaire, L. B. Cross and S. F. Eichner, 2004. Treatment of migraine headaches with sumatriptan in pregnancy. Ann Pharmacother. 38, 1726-30.
(2) C. Olesen, F. H. Steffensen, H. T. Sorensen, G. L. Nielsen and J. Olsen, 2000. Pregnancy outcome following prescription for sumatriptan. Headache 40, 20-4.
Uploaded 06-04-2006
Menstruation migraine is hard to treat
A survey of 511 women, who had had a total of 1,232 migraine attacks, showed that the effect of Zomig was less when used on menstrual migraine than on attacks at other times.E. Loder, S. D. Silberstein, S. Abu-Shkra, L. Mueller og T. Smith, 2004. Efficacy and tolerability of oral zolmitriptan in menstrally associated migraine: a randomized, prospective, parallel-group, double-blind, placebo-controlled study. Headache 44, 120-130.
Uploaded 02-03-2005
Female migraineurs react more strongly to light after their menstruation
A small test on 5 women with menstruation migraine and 5 control women demonstrated that the migraineurs reacted more strongly to light than non-migraineurs did.The migraineurs reacted to light especially 4 – 5 days after their menstruation and just prior to it. Their reactions were recorded as the circulation of blood at the visual centre at the back of the brain.
The periods just before and just after menstruation were chosen because the oestrogen content of the blood is low just prior to and high just after menstruation.
B. M. Ances and J. A. Detre, 2003. Perfusion changes with photic stimulation during two phases of the menstruational cycle: a pilot study comparing controls and true menstruational migraine patients. Cephalalgia 23, 907-913.
Uploaded 02-03-2005
Children of migraineur mothers have adult responsibilities early
Mothers with migraine know it – we ask our children to do some of the many tasks we cannot cope with ourselves. Now it has been documented that children who have a mother with migraine and a father without this problem are asked to do more ‘adult’ tasks than children of other mothers. The study also documented that the migraineur mothers are just as caring and have as much empathy as other mothers and they do not punish their children more than others.M. A. Fagan, 2003. Exploring the relationship between maternal migraine and child functioning. Headache 43, 1042-1048.
Uploaded 02-03-2005