Migraine diagnosis may be missed in women

Oct. 28, 2005
Roughly 60 percent of women suffering from migraines have never even been diagnosed with the condition.

By Jennifer Wider, MD

Chances are you've had a headache. Most people have. But if you're a woman and suffer from migraines, you may not have received a proper diagnosis. In fact, roughly 60 percent of women suffering from migraines have never even been diagnosed with the condition, according to the National Migraine Awareness Group based in Alexandria, Va.

Katrena Potashnick, a long-time migraine sufferer from Springfield, Mo., knows the statistics all too well.

"I suffered from horrible headaches from 1988 to 2003. It took all those years to get a proper diagnosis," Potashnick said. "I went to the Headache Care Center [in Springfield] in the spring of 2003 and finally was diagnosed with migraines."

On average, women suffer from all types of headaches more frequently than men. Migraines are roughly three times more common in women. This disparity between the sexes increases from the onset of puberty through a woman's mid-40s, and then starts to decline after menopause. This pattern strongly suggests that estrogen levels play an important role in the higher prevalence among women.

Headaches can make getting through the day a little bit harder, but the pain from a migraine can be debilitating. The pain typically affects one side of the head and can be sharp or throbbing in nature. The pain can range from mild to severe and interrupt daily activities. Sufferers can become sensitive to light and sound and may experience nausea and vomiting. The attacks can last for a few hours or a few days. About one-fifth of sufferers experience an aura, or visual disturbances before the actual onset of the headache.

"My most common symptoms were fatigue, sinus congestion, nosebleeds and a horrible headache with blurred vision," Potashnick said. "Vomiting came with it in the later years."

Diagnosing a migraine can be difficult because the symptoms and triggers vary from person to person, as do responses to treatments.

"The most common symptom of a migraine is nausea, although it is not necessary for the diagnosis," said Stewart J. Tepper, MD, co-director of the New England Center of Headache, in Stamford, Conn., and assistant clinical professor of neurology at Yale University School of Medicine. "Almost any stable pattern of at least six months of episodic, disabling headache is considered a migraine."

Studies have shown that migraines in women are often triggered by the onset of puberty, synthetic estrogens in birth control pills, and hormonal replacement therapy. In addition, migraines are frequently experienced right after women give birth when estrogen levels sharply decline.

"In general, a drop in estrogen, especially at the beginning of menses, is a trigger for migraine headaches," Tepper said.

Migraine headaches are treatable. Because many people suffer from migraines without a proper diagnosis, it is vital to identify the type of headache you suffer from in order to get the necessary treatment. There are a variety of medications, including general pain relievers, migraine-specific agents, beta-blockers and anti-depressants, proven to help. It is also possible to prevent migraines by learning to avoid potential triggers. Working closely with a health care professional will optimize your ability to manage and treat migraine pain effectively.

Individuals can learn more about migraines and take a headache assessment quiz by visiting www.womenshealthresearch.org. Additional information is also available from the National Headache Foundaton, on the Internet at www.headaches.org.

Silberstein SD, Merriam G. Sex hormones and headache. J Pain Symptom Manage 1993;8:98-114.

MacGregor EA. Menstruation, sex hormones, and migraine. Neurol Clin 1997;15:125-141.

Dr. Jennifer Wider wrote the above article for the Society for Women's Health Research on October 13.