Articles

Heading Off Migraines in Women

By Rita H. Boone, R.Ph., J.D..

Migraine headaches affect 2-15% of the world’s population. Of the 28 million Americans with migraine, approximately 20 million are women. Migraine headache can be debilitating and incapacitating; lasting several hours or, in some cases, several days.

Some or all of the following symptoms are typical of migraine headaches:

1. Moderate to severe pain which may be unilateral or bilateral,
   
2. Pain with a pulsating or throbbing quality,
   
3. Pain that is aggravated by routine activity,
   
4. Pain that is associated with nausea and sometimes vomiting,
   
5. Sensitivity to light and sound,
   
6. Attacks that occur between once a week and once a year (median one per month)
   
7. Are often accompanied by an "aura", which is defined as a sensory warning sign, such as flashes of light, blind spots or tingling in your arm or leg.
   

The headache history should cover how many different types of headaches you experience, time of first onset, frequency, duration, character and location of pain, predisposing and/or aggravating factors, family history, current treatment protocol, and impact on quality of life. The headache diary should track the same data on a daily, qualitative and quantitative basis.

To properly manage migraine headache it is important to identify risk factors and triggers. These include, but are not limited to, stress, depression, and head or neck trauma.

One common trigger of migraines in women is the hormonal changes associated with fluctuations in estrogen. Estrogen modulates vascular, serotonergic tone and influences concentrations of endogenous, pain-relieving beta-endorphins. Menstruating women often report headaches immediately before or during their periods which corresponds with a major drop in estrogen. Pregnancy and menopause have also been identified as times corresponding with increased migraine headache. Oral contraceptives (high dose estrogen forms particularly) appear to worsen migraines as well. The migraine appears to occur during the days off the oral contraceptive; once again correlating with a major drop in estrogen.

Treatment options for migraine headache often include acute therapy and prophylactic strategies. The strategy selected should correlate closely with the frequency and severity of the headaches, the degree of disability associated with the headaches, and other comorbidities. Note, however, that some medications are contraindicated during pregnancy, have addictive properties, and/or cause severe rebound headaches.

Acute therapy often includes various combinations of drugs such as ibuprofen, acetaminophen, aspirin, and caffeine, opiates such as codeine and anti-nausea medications (metoclopramide or prochlorperazine). However, a class of drugs known as triptans have become the drug of choice for many because they are effective in relieving pain, nausea and sensitivity to light and sound that are associated with migraine. Triptans include Imitrex, Maxalt, and Relpax.

Preventive therapy may include traditional medication, lifestyle changes, and non-traditional therapies. Traditional medications include beta blockers such as verapamil and lisinopril, anti-depressants such as amitriptyline and nortriptyline, anti-seizure drugs such as Depakote, Topamax and Gabapentin, anti-histamines such as Cyproheptadine, and Botox.

Life-style changes include avoidance of triggers, and muscle relaxation exercises. Non-traditional therapies include acupuncture, biofeedback, and herbs and vitamins such as B-2, coenzyme Q-10, oral magnesium sulfate.

At Bellevue Pharmacy we offer the following treatment options for migraine headache. For patients on hormone therapy, we work with them and their physician to carefully monitor the temporal relationship between migraine headache and fluctuations in estrogen levels and recommend adjustments in estrogen dosage for prophylactic treatment of migraine in appropriate cases.

We also compound a variety of medications that are unavailable commercially for treatment of migraine headaches. These include:

1. Lidocaine nasal spray (local anesthetic),
   
2. DHE nasal spray (vasoconstrictor),
   
3. Metoclopramide, aspirin, and ginger root capsules (anti-nausea/pain),
   
4. Ergotamine sublingual tablets (vasoconstrictor), and
   
5. Anti-nausea capsules containing B6, B12, folic acid, calcium carbonate, and ginger root.
   

Bellevue Pharmacy is dedicated to providing our patients with all the information they need to live happy and healthy lives. The pharmacists at Bellevue Pharmacy are always available to answer your questions and consult with your physicians about treat option.

We hope the information above contributes to your fund of knowledge about Bellevue Pharmacy and your health.

1. Clinical Review-Division of Neuroscience Imperial College, London BMJ Vol 325 19 Oct 2002.
   
2. Managing Menstrual Headache, National Headache Foundation, Mannix, Lisa K., M.D. 2004.
   
3. http://www.mayoclinic.com,health/migraine headache/DS00120.
   
4. The Lancet, Vol. 358, November 17, 2001.
   
5. National Headache Foundation Headlines, April 2007, www.headaches.org.
   
   
   ---
   

   Back to Articles