Women and Migraine
Three times as many women as men get migraines, and experts believe that hormones play a big role. "In children, the prevalence of boys and girls with migraine is equal," says Mannix. "The discrepancy doesn't begin until puberty when girls start menstruating and having hormonal fluctuations."
The NHF estimates that more than half the migraines in women are menstrually related, occurring right before, during, or after a woman has her period. Some women report that these menstrual migraines are more severe and last longer than migraines they may have at other times of the month.
"There is strong evidence linking migraine with estrogen," says Mannix. Estrogen levels drop right before a woman has her period, and this fall in estrogen may trigger a migraine attack in some women. During pregnancy, when estrogen levels are high, some women have fewer and less severe migraines.
After menopause, when estrogen levels are low, some have fewer attacks and milder symptoms, but others have worse migraines. "About two-thirds of female migraineurs improve with menopause, but one-third do not," says Bastings. "Changes in estrogen level can trigger different reactions among patients, and it is not clear why this happens."
"Women should not have to tolerate menstrual migraine pain," says Mannix. "It is treatable. The most important thing is that women get diagnosed and work with their health care provider to get the best treatment."
Some studies have associated migraine with an increased risk of stroke, particularly in women younger than 45 who get migraine with aura. "The evidence is very solid that these women are at increased risk for stroke," says Lipton. They have three times the risk than that of women younger than 45 who do not have migraines, he adds. "That may seem like a scary statistic, but even though the relative risk triples, the absolute risk is very, very low." This means that the risk for women younger than 45 without migraine is 10 per 100,000 versus 30 per 100,000 for women younger than 45 with migraine with aura.
A woman who has migraine with aura, takes oral contraceptives, and smokes goes from a three-fold risk for stroke to a 12-fold risk, says Lipton. "I'm not saying that women with migraine should not take oral contraceptives," he adds, "but I am advising them not to smoke."
Children and Migraine
Migraines are most commonly experienced between the ages of 15 and 55, but children and adolescents are not immune. The American Academy of Neurology estimates that migraines occur in 3 percent of preschool children, 4 to 11 percent of elementary school children, and up to 23 percent of teen-agers.
Children with migraine tend to have pain on both sides of the head, usually without aura. They often have nausea and excessive vomiting. Some children get "abdominal migraine," vomiting with no headache. According to the NINDS, researchers have found that these children usually develop headaches as they get older.
No OTC or prescription migraine products currently are approved for use in children, but physicians may recommend that children take certain drugs approved for adults, with careful monitoring.
