Throbbing migraine headaches distress more women than men

Dr. James featured in recent Rochester Business Journal article.

“When things are changing, a migraine sufferer may notice her condition worsen,” says Lesley James M.D., a board-certified family physician who recently opened an integrative medical practice in Pittsford.

Marisa Genier is one of roughly 30 million Americans who suffer from migraines, an ailment that affects three times more women than men.

“The pain is literally debilitating,” says Genier, 33, a nurse at Strong Memorial Hospital and mother of an energetic 3-year-old. “It stops me in my tracks in the middle of a busy day. And there’s nothing that I can do.”

The throbbing pain of a migraine can be excruciating and cause blurred vision, nausea, even vomiting. Sensitivity to light or noise may leave a chronic migraine sufferer unable to work or function normally for days at a time.

“Migraines are very common but often go undiagnosed,” says William Faber M.D., senior vice president of Rochester General Health System and executive medical director of Rochester General Medical Group.

Faber, former member of the National Headache Foundation, estimates that only half of all migraine sufferers are actually being treated.

“Headaches are trivialized in our culture,” he says. “It’s common and regrettably assumed that it can’t be that severe or that you’re a wimp, but migraine phenomena is an actual illness with a physiological reason.”

While the direct cause of a migraine is not fully understood, it is known that three out of four migraine sufferers are women between the ages of 20 and 45. This predilection can be linked to estrogen.

Estrogen and hormonal fluctuations, particularly around the time of menses, often trigger migraines in women who have a propensity toward the condition. Unfortunately this often coincides with the time in a woman’s life when she may also face the most career, home and social obligations. Stress levels can be difficult to manage, and relaxation may be infrequent; both factors can be triggers in women predisposed to migraines.

“When things are changing, a migraine sufferer may notice her condition worsen,” says Lesley James M.D., a board-certified family physician who recently opened an integrative medical practice in Pittsford.

These changes can include factors such as the onset of puberty, menopause or even a sudden increase or decrease in stress levels.

“If a woman goes from being very busy and then suddenly takes a moment to relax, that alone can trigger a migraine,” James says.

She finds that many health problems are diet-related. Migraines in particular are known to be brought on by certain foods, including caffeine, red wine, chocolate, cheeses and foods containing monosodium glutamate, such as soy sauce, or nitrates, which are found in hot dogs or lunch meats. It is recommended that a patient keep a headache diary to help track and determine possible migraine generators.

Other migraine triggers include environmental and emotional factors such as sleeping too much or too little, stress, anxiety or changes in the weather. Scientists in Sweden have found that exercise can be as effective as medication at preventing migraines. Massage can help reduce neck tension and promote relaxation, and consistent acupuncture can also target areas of migraine pain.

Some evidence suggests that supplements such as coenzyme Q10 and herbs such as feverfew and butterbur may decrease the frequency and intensity of headaches. Still, an individual who is successful in determining which foods spark a migraine and eliminating those from the diet remains most likely to reduce the frequency of migraines.

“I look at food as medicine. Your diet has a huge impact on your health,” James says. “I think for things like migraines … there are gentler approaches that can be really effective and work synergistically with (more traditional) medications.”

A chronic migraine sufferer can experience 10 migraines in an average month, some lasting as long as three days, according to Raissa Villanueva M.D., a neurologist at the University of Rochester Medical Center.

Villanueva estimates that 90 percent of her patients are women, and they range in age from 16 through their mid-80s.

“If you take into consideration missed days of work, possible emergency department visits …, the quality of life of a migraine sufferer can really be affected,” she says.

The onset of a migraine often is preceded by an aura, a period of 30 minutes to an hour before the headache occurs in which warning symptoms such as numbness or tingling appear.

This offers the migraine sufferer an opportunity to use an abortive treatment, such as triptans, a family of medications introduced in the 1990s to treat migraine or cluster headaches. While there remains no cure, triptans act on receptors in the body and prevent the dilation of blood vessels that causes migraines. Otherwise, acute “rescue” medications such as anti-inflammatory or pain medicines can be taken.

Villanueva also recommends Botox to patients. Commonly known for its aesthetic uses, such as smoothing wrinkles, the treatment has also been approved by the U.S. Food and Drug Administration to treat chronic migraines in adults.

A chronic migraine sufferer has 15 or more days each month when a headache lasts four or more hours per day. The Botox treatment identifies trigger points in the head and muscles, and injection into these points can reduce the frequency of attacks.

Botox could be an option for migraine suffers such as Genier, who is currently expecting her second child and is unable to use even the most common headache medicine to alleviate her pain.

“I’m a working mom, and not only is most medication not an option right now, neither is rest,” Genier says.

She has found acupuncture to help and is an advocate of a healthy diet, including green tea and plant-based nutrients.

While much about migraines remains unknown, the options for relief are as varied as the individual sufferers. As with all forms of healthy living, successful results take time and commitment, James says.

“It’s just so important, especially for women,” she says. “We need to take time to nurture and nourish ourselves.”

%d bloggers like this: