Migraine

According to the National Headache Foundation, about 28 million Americans are affected by migraine headaches (National Headache Foundation 2004). Although migraine was recognized by ancient doctors, its cause is still disputed by experts on the disorder. Even today, no single hypothesis has been accepted by conventional science.

Perhaps because of the confusion surrounding the cause of migraines, conventional medicine has not been able to effectively approach this debilitating condition.

What Is Migraine?  Migraine headaches, often referred to as vascular headaches, are usually classified as either common migraine or classic migraine. A classic migraine is preceded by an aura with characteristic visual, sensory, or motor symptoms. Aura usually includes visual abnormalities (e.g., flashes, shimmering, and other hallucinations that seem to migrate through the visual field) and neurological abnormalities such as tingling sensations (Kasper DL et al 2005; Silberstein SD et al 1995b).

Migraine attacks often include features that occur in sequence, including the following:

• Prodrome: This stage is marked by a change in mood that begins hours or days before the headache. Symptoms of the prodrome include depression, sleepiness, talkativeness, restlessness, or other alterations.
• Aura:  Aura is usually characterized by visual abnormalities, including flashes, shimmering but you may experience a smell, sound or other hallucinations.
• Headache phase: The headache itself is typically one sided but may affect both sides of the head. It is usually gradual in onset, moderate to severe in pain intensity, throbbing, and worse with physical exertion, and it can last anywhere from 2 hours to 2 days in children and 4 hours to 3 days in adults (Silberstein SD et al 2003; Joubert J 2005). The frequency of migraine attacks is unpredictable. The headache stage is often accompanied by loss of appetite, nausea, vomiting, sensitivity to light and sound, blurred vision, tenderness of the scalp or neck, lightheadedness, sweating, and pallor (Silberstein SD et al 2003; Silberstein SD 1995a).

Migraines are about three times as common in women as in men (Lim C 2005; Breslau N et al 2001; Lipton RB et al 2001), and they typically begin between the ages of 10 and 40. The frequency of migraine headaches appears to increase with age, with peak frequency in women during their 30s and 40s and in men during their 30s, and then seems to decrease (Henry P et al 1992). Among some women, migraines decrease in severity or disappear entirely during menopause ( Silberstein SD et al 2003). Many women note that their migraine attacks occur in connection with their menses, and abnormal hormone levels are closely associated with migraine headaches (Recober A et al 2005). Clearly, migraine's close correlation with sexual maturity and menopause in women suggests that steroid hormones are involved in the disease.  Migraines are closely associated with hormonal changes in women, especially with menstruation.

Migraine headaches also tend to run in families, and there is a definite genetic predisposition (Kasper DL et al 2005). More than 50 percent of migraine sufferers have a relative who also suffers from migraine.   Migraines have frequently been found to coexist with psychiatric disorders (e.g., anxiety and major depression), neurotic personality, stroke, and epilepsy.

Several lifestyle factors may trigger a migraine headache and include the following:

• Lack of sleep
• Consumption of alcohol, especially red wine and beer
• Excessive exercise
• Consumption of foods containing monosodium glutamate or nitrates
• Consumption of other potential food triggers, including chocolates, aged cheese, dairy foods, caffeine, fermented or pickled foods, shellfish, and wheat
• Emotional stress
• Use of certain medications may trigger a migraine and include the following:
• Birth control pills or conventional hormone replacement therapy with synthetic estrogens and progestins
• Drugs that dilate the blood vessels, such as Viagra ® (sildenafil)
• Antimigraine drugs used excessively, which can cause rebound migraine

Migraines also may be triggered by the overreaction of blood vessels to a variety of factors including the following:

Menstruation, Weather, Head trauma, Fatigue, Glaring lights, Changes in altitude or time zone, Perfumes or other powerful odors.

There is little doubt that migraines are closely related to hormonal imbalance in both men and women. Because migraine occurs most often in women and is closely related to menstruation, most of the clinical studies examining migraines and hormones have been conducted in women. Their findings reveal that a deeply disturbed hormone regulation system is closely linked to the frequency and severity of migraines.  Migraine headaches increase among women after puberty, and many women have migraines that are closely associated with menstruation (Beckham JC et al 1992). Estrogen withdrawal has been described as a trigger for migraine headache, which explains why some women suffer from migraines when estrogen levels are low (Misakian AL et al 2003). However, conventional estrogen replacement therapy with oral synthetic estrogens is not always able to relieve migraines.  It works for some women, but in others, estrogen therapy appears to worsen migraines (Chavanu KJ et al 2002). Similarly, in a recent study examining 17,107 postmenopausal women, migraine was more common among women who were on conventional hormone replacement therapy (Misakian AL et al 2003).  Another study noted that it was difficult to predict which postmenopausal women would suffer from worse migraines because of conventional hormone replacement therapy (Hodson J et al 2000). These studies examined women on conventional hormone replacement therapy, which includes strong equine estrogens synthesized from the urine of pregnant mares.

Although researchers are still looking for an explanation, it appears that progesterone levels may help explain the trial data.  During a typical monthly cycle of a healthy premenopausal woman, estrogen levels rise during the first part of the cycle. After the egg is released, progesterone levels rise quickly to prepare the uterus for implantation, and the levels of estrogen decline. If implantation does not occur, levels of progesterone and estrogen both decline quickly, and menstruation occurs to prepare the uterus for another cycle. By carefully studying women with menstrual migraines during this cycle, researchers made some interesting discoveries. Essentially, they found that migraines are more severe and disabling during the phase of the cycle when estrogen is dominant and that women with relatively higher levels of progesterone fared better on a headache outcome index (Martin VT et al 2005).

This research suggests that it is not the absolute levels of estrogen that are associated with migraine among women but rather an imbalance between estrogen and progesterone. This theory would also help explain why conventional hormone replacement therapy among postmenopausal women sometimes exacerbates migraine headaches: it is not necessarily the withdrawal from estrogen but perhaps the imbalance between estrogen and progesterone that occurs when postmenopausal women take strong synthetic estrogens during conventional hormone replacement therapy.

It is our practice to use only properly balanced bioidentical hormones administered topically in cream form.  We do not use any synthetic hormones, oral administered hormones.  In addition, we use a variety of supplements and stress reduction techniques to help our patients who suffer from headaches.

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