What is a migraine and how does it differ from tension headaches?

Tension headaches are usually described as a continuous pressure pain or tightness of varying severity over the entire head, whereas migraine headaches are a severe, throbbing pain over one or both temples, or behind one eye or ear, and are often accompanied by nausea and vomiting. A migraine often starts on waking up in the morning, but can occur later in the day and can last hours to one or two days. In individuals with a form of migraine called classic migraine, visual symptoms described as bluriness, dazzling zigzag lines, blind spots or sensitivity to light occur just before and sometimes during the headache. While fatigue and stress can sometimes bring on both tension and migraine headaches, bright lights, noise and alcohol are specific factors that can trigger a migraine.

Are women more prone to migraine headaches?

Yes. In fact, 20 million women in the U.S. suffer from headaches; 9 million of whom suffer debilitating migraines. Over a quarter of women are affected by migraines during their life. Although these headaches are common among both men and women, there are important differences. The prevalence of migraine is 2-3 times higher in women. The character of the headaches also differs. Women tend to report higher levels of pain, longer duration of headaches, and more associated symptoms, such as nausea and vomiting. Visual symptoms are also less common in women.

There is a long recognized association between ovarian hormones and migraine. Over half of women with migraine report an association between their headaches and their menstrual cycle. The frequency and severity of migraine is increased commonly with the use of oral contraceptive pills and during the menopause. In addition, changes in the levels of ovarian hormones and prolactin during pregnancy and breast-feeding may modify the course of a migraine. A better understanding of these changes is leading to better treatment of migraine.

How do you treat a migraine at home?

Sometimes - At the onset of a migraine, lying down in a dark room with a cold compress can bring relief, along with over-the-counter drugs including acetaminophen or aspirin with caffeine. You may want to talk with your doctor about ways to prevent future migraines.

What if home remedies don’t work?

Women with moderate migraines may need prescription drugs for relief. These could include agents that affect neurotransmitters (the chemicals that are the messengers in the brain) such as sumatriptin and various antidepressants. Other drugs might include agents that dilate blood vessels in the brain. In some cases, doctors prescribe painkillers.

Some drugs can be given intranasally, through a transdermal patch (on the skin), oxygen inhalation, and laser therapy to the maxillary nerve.

Because migraine is affected by hormonal fluctuation, estrogen use during the premenstrual period is sometimes helpful. However, ironically, estrogen may also trigger migraines. Women should discuss with their physicians use of estrogen such as oral contraceptives and hormonal therapy for migraines.

To help your doctor find the right treatment for you, keeping a "headache calendar" is important, documenting the time of day, point in your menstrual cycle, your location (at work, at home, at the park, etc.) and your activity when the migraine started.

Is there anything I can do to prevent a migraine?

Because stress often triggers migraines, women who are habitual sufferers should learn relaxation and stress management techniques. These are especially helpful in aborting headaches when warning signs are felt. Massage, relaxation exercises of the neck, shoulder, and jaw muscles may all be helpful. Rest in a dark room with cool compresses can prevent the headache. Foods such as alcohol, aged cheeses, chocolate, fermented or marinated foods, MSG, artificial sweeteners such as aspartame, and caffeine all may trigger headaches; diet should be monitored to reduce or eliminate intake of these. Nicotine may cause migraine - yet another good reason to give up smoking! In summary, each woman's migraine pain, her triggers, and her "headache calendar" (when headaches tend to occur) are unique. Treatments are also unique for each case. Women need to consider their individual triggers, lifestyle issues such as stress level and eating habits, and their own preferences for medication as they and their physicians choose treatments.