By Karyn Odway

An estimated 36 million Americans suffer from migraines, and most of them are women. Headaches are three times more common in women than men (18% in women vs 6% in men), which means women more than men could experience the debilitating effects of a headache. But new treatments and techniques are bringing hope in the management of migraines.

A migraine is defined by two of the following four symptoms: pain typically on one side of your head, throbbing pain, moderate to severe pain and worsening with movement plus symptoms of nausea or vomiting and/or sensitivity to light and sound.

Migraine Treatments

“Treatment of migraines can be divided into four categories although we often need to combine them to get control,” says Neurologist Susan Rubin, MD, the Ruth Cain Ruggles Chair of the Department of Neurology at NorthShore and Co-Chair of NorthShore Neurological Institute.

1. Trigger management. Managing triggers can be helpful but is the hardest to do since some triggers are outside your control (weather), some you cannot avoid (lighting at your workplace) and some often are a combination of things, so avoiding one may not do the trick.  If you can identify a trigger that clearly causes a migraine and you can avoid it (such as drinking red wine), you should but it may not solve the whole problem. Some common triggers include changes in the weather (barometric pressure), bright sunlight, red wine, dehydration, menstrual cycle, missed meals, processed meats, aged cheese, stress, and a lack of sleep/too much sleep. Keep in mind, headaches often are triggered by a combination of things such as being more sensitive to certain foods when the weather is changing or drinking wine when overtired.
2. Abortive medications. These medications are pain relievers to help ease a headache when it occurs.  Migraine specific medications like triptans should be used early during a headache to get prompt relief, but they shouldn’t be used frequently since that can promote rebound headaches due to medication overuse.
3. Preventative medications. These medications are used to help decrease the frequency and intensity of headaches.  We typically recommend them in anyone who has more than three to four headaches a month.  There are many medications that can act as preventatives but the calcitonin gene-related peptides (CGRP) inhibitors are the first designed specifically for migraine prevention. They were first FDA approved in 2018 with both long-acting preventatives and short acting abortive medications coming on the market since then. Even though the CGRP inhibitors have proven highly effective for many patients, Dr. Rubin adds, “We just completed a study on how NorthShore patients react to the different medications in this class. We want to provide more targeted treatments, so we hope to know if certain patients respond differently to certain medications and whether one of the CGRP inhibitors work better than any of the others.” Study findings should be complete by Spring 2023.  
4. Alternative treatments. These can also be an option for management of migraines. Dr. Rubin recommends some natural treatments too for this female predominant disorder.

• Good health practices. Incorporate neck/shoulder stretching exercises, avoid “trigger” foods and environments.
• Supplements. Try magnesium, 500-600mg daily and vitamin B2/riboflavin, 400mg daily.
• Complementary medicine. Consider acupuncture, massage, biofeedback.  

The Role of Hormones

The frequency of migraines might change over time – for better or worse.

“Headaches often start during puberty when a girl starts menstruating and then continues throughout her life. Some women are particularly susceptible to headaches around their menstrual cycle and at ovulation,” Dr. Rubin said. “Those women often do better during pregnancy and improve at menopause.  But that is not the only trigger for migraines and women who have many or different triggers may not notice a hormonal pattern. They may do worse during pregnancy, especially if they stopped medication for the pregnancy, or continue to have migraines postmenopausal.”

Dr. Rubin suggests the following when it comes to using medications to treat migraines over a woman’s lifetime.

• Young Women. Most of the medications (preventative and abortive) are approved for adults 18 or older although some of the migraine specific pain relievers (triptans) have been approved for females as young as age 12. 
• Pregnant Women. During pregnancy migraine medications are not recommended, but women can use more of the alternative treatments to help maintain control. 
• Menopausal Women/Postmenopausal Women. Older adults need to consider co-morbid conditions that could limit the pain reliever use due to possible interactions with their other medications. That said, a preventative could treat both the headaches and their other medical conditions. For example, doctors could recommend using a beta-blocker for a patient with frequent headaches and high blood pressure.

“We don’t know why women have more headaches, but cycling hormones clearly play a role,” Dr. Rubin adds; “however, by following the above principles of migraine management, you don’t have to suffer from them.”

To learn more about headache management, visit the NorthShore Neurological Institute's headache program.