Why Are Young and Middle-Aged Women More Prone to Migraines?

 

Migraine: A Comprehensive Overview

Migraine is a complex neurological disorder that primarily affects the brain's blood vessels and surrounding nerve fibers. It's more than just a headache—it's a chronic condition characterized by recurrent attacks of moderate to severe pain, often accompanied by other debilitating symptoms. Affecting about 12% of the global population, migraines are three times more common in women than in men, particularly affecting those in their young and middle adult years.

ICD Definition and Classification

According to the International Classification of Diseases (ICD), migraine is defined as a "class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches." The pain associated with migraines is typically throbbing and pulsatile, which sets it apart from tension-type headaches. In many cases, it presents on one side of the head (unilateral), although it can switch sides or occur on both sides.

Major Subtypes of Migraine

There are several types of migraines, but the two most common subtypes are:

1. Common Migraine (Migraine without Aura)

   • No neurological symptoms: This form lacks the sensory disturbances known as "aura" that precede or accompany the headache.
   • Most frequent type: About 70-90% of individuals with migraine experience this type.
   • Symptoms: Throbbing pain on one side of the head, nausea, vomiting, and sensitivity to light and sound.

2. Classic Migraine (Migraine with Aura)

   • Presence of aura: This subtype is accompanied by an aura—temporary neurological disturbances that often occur before the headache. Auras can last from 5 to 60 minutes and may include:
     • Visual disturbances (flashing lights, zigzag lines, or blind spots)
     • Sensory changes (numbness, tingling, or weakness)
     • Difficulty speaking or understanding speech (in rare cases)
   • Less common: This type affects about 25-30% of people with migraines.
   • Risk of Stroke: Migraine with aura is associated with a slightly higher risk of ischemic stroke, particularly in women.

Phases of a Migraine Attack

Migraines typically progress through four distinct stages, although not everyone experiences all of them:

1. Prodrome (Warning Stage)

   • Occurs hours to days before the migraine attack.
   • Symptoms: Mood changes, food cravings, neck stiffness, frequent yawning, constipation or diarrhoea, and increased urination.

2. Aura

   • Occurs in about 25-30% of migraine patients, usually lasting less than an hour.
   • Common auras include visual disturbances, numbness, tingling in the face or hands, and language difficulties.

3. Headache Phase

   • The primary migraine pain phase typically lasts from 4 to 72 hours.
   • Unilateral, throbbing pain: Pain often localized to one side of the head but can shift or affect both sides.
   • Nausea and Vomiting: Many sufferers also experience severe nausea and vomiting.
   • Sensitivity: Exacerbation of symptoms with light (photophobia), sound (phonophobia), and sometimes odours.

4. Postdrome (Migraine Hangover)

   • Occurs after the headache resolves, lasting from a few hours to a day.
   • Symptoms: Fatigue, dizziness, confusion, and a general feeling of malaise. Some people feel euphoric, while others may feel drained.

Migraine Triggers

Migraines can be triggered by a wide range of factors, which vary between individuals. Some of the most common triggers include:

1. Hormonal Changes:

   • Menstrual migraines: Hormonal fluctuations, particularly estrogen, play a significant role in triggering migraines in women. Many women experience migraines before or during menstruation (referred to as menstrual migraines).
   • Migraines may also worsen during pregnancy, perimenopause, or with the use of hormonal contraceptives.

2. Dietary Triggers:

   • Certain foods and drinks are common migraine triggers. These include:
     • Alcohol, particularly red wine and beer.
     • Aged cheeses and processed meats (due to high levels of tyramine).
     • Food additives like MSG (monosodium glutamate).
     • Excessive caffeine or caffeine withdrawal.
     • Artificial sweeteners (e.g., aspartame).

3. Environmental Factors:

   • Bright or flashing lights, loud noises, or strong odours can precipitate a migraine attack.
   • Weather changes, such as shifts in barometric pressure, are also linked to migraines in some individuals.

4. Stress and Anxiety:

   • Emotional stress is one of the most commonly reported triggers. It may exacerbate the frequency and intensity of migraines. Conversely, migraines can also cause significant stress, creating a vicious cycle.

5. Sleep Patterns:

   • Both sleep deprivation and excessive sleep can trigger migraines. Maintaining a consistent sleep routine can help prevent migraine attacks.

6. Physical Exertion:

   • Intense physical activity, especially without proper hydration, can trigger migraines in some people.

Pathophysiology of Migraine

The exact cause of migraines is still not fully understood, but researchers believe it involves a combination of genetic, vascular, and neurological factors. Some of the key mechanisms involved include:

• Cortical Spreading Depression (CSD): A wave of electrical activity spreads across the brain’s cortex, leading to changes in blood flow, which may be linked to the aura experienced before a migraine attack.

• Trigeminal Nerve Activation: The trigeminal nerve, which supplies sensation to the face and head, plays a central role in migraine. Activation of this nerve leads to the release of neuropeptides such as calcitonin gene-related peptide (CGRP), which cause blood vessels to dilate and lead to inflammation, resulting in the characteristic migraine pain.

• Serotonin Dysregulation: Low levels of serotonin, a neurotransmitter, are thought to contribute to migraine attacks. Many migraine medications work by stabilizing serotonin levels.

Treatment Options for Migraine

Managing migraines often requires a combination of lifestyle changes, preventive strategies, and medications. Treatment can be divided into two main categories:

1. Acute (Abortive) Treatments:

   • Designed to stop a migraine attack once it has started. Common medications include:
     • Triptans (e.g., sumatriptan, rizatriptan): These drugs constrict blood vessels and reduce inflammation by affecting serotonin receptors.
     • NSAIDs (e.g., ibuprofen, aspirin): Help relieve migraine pain and reduce inflammation.
     • Ergotamine: Another class of drugs used to treat migraine attacks, particularly in those who do not respond to triptans.
     • Anti-nausea medications: These help alleviate nausea and vomiting associated with migraines.

2. Preventive (Prophylactic) Treatments:

   • Aimed at reducing the frequency and severity of migraine attacks. These are taken daily, regardless of whether a migraine is occurring.
   • Common preventive medications include:
     • Beta-blockers (e.g., propranolol).
     • Antidepressants (e.g., amitriptyline).
     • Anti-seizure medications (e.g., topiramate, valproate).
     • CGRP Inhibitors: A newer class of drugs that block the effects of CGRP, which is involved in causing migraine pain.
     • Botox injections: Approved for chronic migraine treatment (15 or more headache days per month).

Lifestyle Management for Migraine

In addition to medications, managing migraines often involves changes in lifestyle and behaviour, including:

• Regular Sleep Patterns: Establishing consistent sleep routines can help prevent migraines.
• Dietary Management: Avoiding known food triggers and maintaining regular meal times can reduce the likelihood of an attack.
• Stress Reduction: Practices such as meditation, yoga, or cognitive-behavioral therapy (CBT) can help manage stress and reduce migraine frequency.
• Hydration: Dehydration is a common trigger, so drinking adequate amounts of water daily is essential.

When to See a Doctor

Seek medical advice if:

• You experience frequent or severe migraines.
• Over-the-counter medications are ineffective.
• The pattern of your migraines changes (e.g., they become more frequent, severe, or are accompanied by new symptoms).
• You develop neurological symptoms (e.g., difficulty speaking, weakness, or vision loss) that are unusual for your typical migraines.

Referance From CureForSure.com