Thirty-seven million Americans suffer from migraines, and women are three times more likely to suffer from them than men.
Not only are migraines physically debilitating, but they are also very costly in terms of medical costs and lost productivity. The World Health Organization even states that migraines are one of the 10 most debilitating illnesses in the world.
Although it is a very common condition, doctors and researchers are not sure what causes migraines.
Dr. Jessica Ailani is a board-certified neurologist specializing in headaches. As director of the MedStar Georgetown Headache Center in Washington, DC, she studies migraines and their treatment.
Ailani wants to make it clear that a “migraine is more than a headache.” The condition can last from a few hours to several days and have several phases.
The “prodrome” phase can begin up to a day before a migraine, with more than 36 potential symptoms like irritability, sensitivity to light and sound, nausea, neck pain, and even food cravings. Some people experience an “aura” – vision changes like flashing lights – during migraine attacks.
During a migraine, patients experience debilitating headaches, sensitivity to light and sound, nausea and insomnia, among other symptoms, sometimes for more than 72 hours.
The final phase is called “postdrome” and includes an inability to concentrate, fatigue and low mood. Symptoms can last up to two days.
All three phases make up migraine and often lead people to miss school, work, and events to cope with the pain.
Although there is still some mystery about what causes migraines, Ailani believes it is “mostly a genetic condition.” However, there are several different genes linked to migraines “one way or another,” and scientists have had difficulty identifying which ones specifically cause them.
“In the early ’90s, there were some big discoveries… where they started to realize that migraine was not an abnormality of the blood vessels, but actually an abnormality of the proteins being released that can increase inflammation and cause this network error,” she explained.
People with a family history of migraines have genes that make “the brain more sensitive to these cycles where there is more abnormal electrical activity,” Ailani said. “A mistimed release of proteins that cause inflammation and network problems” is experienced as intense headaches called migraines.
How hormones influence migraine attacks
Ailani said little was taught about hormones when she was in medical school. But she realized that “hormones are incredibly important in everything.”
This interaction between hormones and migraines could explain why women are three times more likely to suffer from migraines than men.
Before puberty, boys are actually more susceptible to migraines than girls. But, once the first menstrual cycle occurs, “the risk of developing migraines begins to increase considerably” for a woman.
A second peak of migraine attacks in a woman’s life occurs in her 40s, when there seems to be “a lot of changing hormones” and estrogen levels become unstable. This instability is also an indication of why when a woman is pregnant, there is “almost complete resolution of (migraine) attacks,” according to Ailani, because estrogen levels tend to be stable and strong.
On the other end of the hormonal spectrum, there are theories that testosterone may be a protective hormone against migraines.
Interestingly, during menopause, when women often experience other symptoms due to hormonal imbalance, “for many women, migraine gets better,” Ailani said. If a woman begins to experience migraines during menopause, she recommends consulting a doctor about the possibility of menopausal hormone therapy.
Much progress has been made in finding better treatments for migraines and providing symptom relief to patients. Botox is a common and effective treatment that can help manage chronic migraines.
The injection is not the same as that used for cosmetic procedures. The needle has to go deeper and may be temporarily painful. Ailani says the treatment is so “effective that people keep coming back.”
Ailani notes that Botox – a form of botulinum toxin – is the only toxin approved by the FDA for the treatment of chronic migraines, but others are being studied and show promise as possible treatments for chronic and episodic migraines.
Innovations in migraine treatment
“One treatment doesn’t work for all patients,” Ailani said. His team at MedStar has been at the forefront of developing new technologies and treatments to manage and even prevent the onset of migraines.
The goal, as Ailani says, is “to get a person to zero, migraine freedom, and living life to the fullest.”
One of the most important developments in this area is a CGRP inhibitor. This type of prescription medication blocks the peptide linked to the calcitonin gene, a small protein found in the nerves of the head and neck that scientists believe plays a role in migraine pain.
What’s particularly “unique,” according to Ailani, is that taking CGRP inhibitors will also help prevent future migraines, becoming more effective over time.
There are also non-pharmaceutical options that Ailani recommends for patients, such as remote electrical neuromodulation, or REN. These devices are applied to a patient’s upper arm and send electrical charges into the muscle to stimulate nerves that “turn off the brain’s pain button.”
Advances in this area give Ailani hope that a person suffering from migraines “can certainly live a much better life with the right treatment.”
Ailani had a message specifically for women living with migraines: “We’re very good at… not taking care of ourselves and taking care of others and saying that everything that’s wrong with us is just nothing.” »
Women sometimes stay silent about their health problems, thinking their pain is normal or part of being a woman.
“Put yourself first,” Ailani said, calling it “one of the most important things to remember.”
Gn Health
