CHARLOTTE, NC – Why migraines affect women at 3 times the rate as men
She’s a women’s neurologist and board-certified headache specialist at Novant Health Neurology and Headache – South Park in Charlotte. Like many of her patients, she’s also a longtime migraine sufferer.
“I know how great it can affect somebody and their quality of life,” she said. “I think it gives me greater empathy into what my patients are experiencing.”
Of more than 100 types of headaches, the one that most often drives pain-wracked patients to her clinic in search of relief is a migraine. And more often than not, those patients are female. Migraines affect three times as many women as men.
We asked Donnelly why — and what women can do to cope.
What are the main types of headaches? There are primary headaches and secondary headaches. Primary headaches are, for example, tension headaches, cluster headaches, and migraines. Secondary headaches are caused by something ominous such as tumors, strokes, bleeds, and aneurysms. My first job is to make sure we’re not missing a secondary headache, which starts with obtaining a thorough history, neurological examination, and sometimes, if warranted, imaging.
What are the symptoms of primary headaches? Sixty percent of the population has had tension headaches. It is the most common kind of headache, but it is mild and doesn’t usually bring patients to the doctor. It causes dull, whole-head, or band-like pressure that is mild to moderate in intensity. Cluster headaches mainly affect middle-aged men who smoke. It causes stabbing pain around the eye and temple on one side, sometimes accompanied by agitation — and registers 10 out of 10 on a pain scale. Fortunately, they’re rare.
The No. 1 reason people go to a headache clinic is migraine — 20% of the population suffers from migraines. These headaches are moderate to severe, last four to 72 hours, and are characterized by throbbing on one side, sensitivity to light and sound, and nausea with or without vomiting — or all of the above. Before the headache begins, some people experience visual disturbances, temporary loss of sight, and numbness or tingling — known as an aura.
What makes women migraine magnets? In a word: hormones. The estrogen drop during a woman’s period is a big trigger, as are the erratic levels of estrogen during perimenopause, the time before her periods stop for good. At times of life when estrogen levels are more steady — during pregnancy while breastfeeding and after nonsurgical menopause — migraines tend to be less frequent. Interestingly, transgender patients who take estrogen as part of a gender transition also experience more migraines — and the same related risk of blood clots as people who were born female.
How do birth control pills affect migraines? Women who take estrogen-containing pills continuously (to skip their period) can see an improvement in migraine frequency. But those who use oral contraceptives (21 days on, seven days on placebo) and still have a period can have an increased number of migraines. That’s because their hormone levels vary. It’s hard to say if progesterone-only oral contraceptives help or hinder in terms of migraine.
One more thing: If somebody has migraine with aura, it can slightly increase their risk of stroke — and it’s something their health care professional should know.
When are headaches concerning in pregnancy? We don’t get worried in the first trimester, but late in the second trimester and in the third, an uptick in headaches or new headaches is concerning and invariably, we do an imaging study. These could be a sign of preeclampsia, among other serious complications.
What part do our genes play? I always ask a patient about family history, because 60+ genes are associated with migraine. If you’re a little girl and your mom has migraines, you know you’re going to be signed up for it as well when you reach puberty.
How does puberty factor in? Puberty brings big hormonal changes, but potentially poor lifestyle choices are also common at that age such as eating junk food, erratic sleeping habits, and inactivity, which can also play a part.
What can girls and women do to keep headaches at bay? Keep a regular schedule — get eight hours of sleep, going to bed and waking up around the same time every day. Exercise — especially aerobic exercise such as walking, running, cycling, or swimming — at least three times a week for 30 minutes each time. (But more is better!) Drink 60 ounces of water a day, eat nutritious meals, and try to maintain a normal blood-sugar level.
What’s the best food to eat? As many as 1 in 5 migraine patients have food sensitivities. Culprits include nitrates, which are found in processed meats; the sulfates in red wine; and tyramines, naturally occurring chemicals in aged cheese.
The most nutritious diets are high in fruits, vegetables, whole grains, and lean proteins. Some people on very low-carb regimens like the Keto diet may have more headaches but the data is mixed. And though some over-the-counter headache remedies contain caffeine, too much coffee can backfire — leading to withdrawal if you stop, followed by rebound headaches.
What about stress? No matter a person’s lifestyle, some things are non-modifiable, like changes in the weather that can contribute to headaches. Up to 60% of headache patients also have anxiety or depression, and we don’t live in a bubble. Analyzing your stressors and figuring out which ones matter and which don’t can be very helpful. Utilizing medication to treat anxiety and depression, and the use of therapy can also be helpful. Mindfulness and meditation or prayer are extremely helpful.
What treatments are in your arsenal? Historically, there were over-the-counter remedies like aspirin, Tylenol and Excedrin Migraine, and old-school medications like Cafergot and Fioricet that were prescribed for nonspecific uses, including headache.
We now favor ones now that are specific for migraine — these acute treatments include Sumatriptan (Imitrex), and other triptans, Ubrogepant (Ubrelvy), Lasmiditan (Reyvow) or Rimegepant (Nurtec).
There are also preventive medications (for those who get more than four migraines per month) that a patient can self-administer monthly or quarterly with a pen-shaped injector, a class of medication called the CGRP monoclonal antibodies. To be eligible for those, you have to have tried and failed on two oral preventatives.
We have many more options today.
At Novant Health, our providers are trained to diagnose and treat all types of headaches and migraines. We want to help you get better and stay well by having our specialists develop a treatment and management plan for you.