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Women And Headache

Why are Headaches of Particular Concern to Women?

Headaches are a particular concern for women for reasons other than their frequency.  In women with migraine, menstruation is a common trigger; this is referred to as "menstrual migraine".  This is different from the headache associated with premenstrual syndrome (PMS), which is more mild.  In women taking birth control pills, migraines may start, worsen, or increase in frequency (although some women experience the opposite effect).  Changing to a lower dose birth control pill may help.  The good news about menopause is that migraines usually decrease dramatically.  Taking estrogen replacement therapy (ERT) may cause migraines to continue, however.  This is not a reason not to take ERT, just another issue to discuss with your health care provider if it affects you.

Headaches and Pregnancy:
In most women, pregnancy actually decreases the frequency and severity of headaches.  In some women, however, migraines may first appear during pregnancy and in some, they may worsen.  Unfortunately, there is no medication other than Tylenol that has been proven safe and effective throughout pregnancy.  As with any medication in pregnancy, discuss the benefits versus risks of treatment even with over the counter medications: there are times when your physician may recommend other headache remedies.  One prescription medication, sumatriptan (Imitrex®) has recently been found to be associated with preterm labor, however, so this medication should be avoided in pregnant women.

Postnatal or Postpartum Headaches:
After labor and delivery, it is very common for mothers to suffer from headaches, usually tension-type. Migraine sufferers may also get postnatal migraines, too, although the headache will probably be milder than a typical full-blown attack. Postpartum headaches correlate with the sharp fall in estrogen and progesterone levels that follow labor and delivery.  This sharp decline is often avoided by women who breast feed.

Psychosocial Impact of Headaches in Women: Nearly half of women migraine sufferers in one survey were unaware of the prevalence of migraine.  Many women of these women felt alone, isolated, misunderstood, or ashamed.  They often questioned the seriousness of their condition and avoided seeking treatment.  Some women suffer in silence out of fear of being perceived as "weak", emotional, hysterical or unable to handle stress.  Ironically, the multiple stressors and roles that many women juggle may contribute to exacerbating a migraine once it starts.  Many women do not have the "luxury" of retreating to a restful, quiet environment to get the respite they need.  Recent research shows that one in three female sufferers of migraine reported that it has affected their ability to be in control of their lives.  Of these women, nearly half (46%) claimed they could not control their plans or activities, or even function during a migraine attack; one in five reported lost confidence in their ability to do their work, could not think clearly, felt "extremely ill" or felt "depressed". According to most of these women, marriages and other relationships suffer as a result; having migraines also affects women's level of sexual satisfaction.

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 While the diagnosis may be a migraine, this diagnosis can only be made after other serious and even life-threatening problems are considered and ruled out. 

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