Hormone changes play a role in development of migraine headaches
DEAR MAYO CLINIC: I'm a 40-year-old woman, and last month I experienced my first migraine headache. Friends have told me that because I've had one migraine, I'll likely get more as I get older, until I reach menopause. Is that true? If so, what can I do to reduce my risk?

ANSWER: First, you should talk to your doctor. Many medical conditions can cause a headache and other accompanying symptoms that mimic migraine. So it's important to get a medical evaluation to ensure you don't have an underlying condition that needs attention.

Migraine headaches are associated with moderate to severe—often throbbing—pain that gets worse with routine physical activity, such as climbing stairs. But additional symptoms, including nausea, vomiting and sensitivity to light and sound, set migraine apart from other headaches. If left untreated, a migraine typically lasts from four to 72 hours. The frequency of these headaches varies considerably from person to person. Some people have migraine attacks several times a month, and others have them much less frequently.

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In some cases, migraine is preceded by an aura—seeing blind spots or bright flashes of light—or a feeling of tingling or numbness on the skin. These symptoms usually last less than an hour. Most migraine headaches are episodic, meaning that people who have them have many headaches over many years, but each attack is distinct and separate from the others. A clinical diagnosis of migraine typically requires a person to have five attacks.

If, indeed, your headache turns out to be a migraine, keep a diary of any future attacks. A headache diary can help you and your doctor determine what triggers your migraine headaches. Note when your headaches start, how long they last, and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also note the foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you're doing when the headaches strike.

Multiple factors appear to increase the risk of frequent migraine headaches. Just being female increases your chances, as women are three times more likely than men to have a migraine attack. Other factors that may increase the risk of more frequent attacks include stressful life events, head trauma, depression, anxiety, excessive use of pain relievers (analgesics), snoring and caffeine use. If any of these factors apply to you, treating, eliminating or managing them would be important to minimize your risk of future migraine attacks.

Hormone changes also seem to play a role in the development of migraine. Many women who have migraine experience headaches just before or shortly after the onset of menstruation. Migraine may also change during pregnancy or menopause. Some women report that their migraine headaches got worse during the first trimester of a pregnancy. For many, the headaches improved later in pregnancy.

Migraine headaches tend to dissipate with age, especially after menopause in women. Half the people who suffer from migraine headaches started getting them before they were 20 years old. Migraine is most common in people between 30 and 39. Although age often seems to help migraine, in about one-third of women the attacks may persist or even increase during or after menopause.

Talk to your doctor about the symptoms you experienced. Your doctor can assess your overall medical situation and offer additional guidance on what to do if you have similar attacks in the future.—David Dodick, M.D., Neurology, Mayo Clinic, Phoenix, Ariz.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. To submit a question, write to: medicaledge@mayo.edu, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.)