MedStar Georgetown University Hospital Headache Center helps women thrive with this debilitating neurological condition from young adulthood through post-menopause
WASHINGTON – Before puberty, migraine headaches are equally as common in boys and girls, but following puberty, migraine becomes 2-3 times more common in women – affecting as many as a quarter of middle-aged women every year in the United States (Lipton et al, 2007). But a better understanding of the mechanism of migraine headaches is leading to advances in care for women who experience this often-times debilitating condition. To help women effectively cope with migraine through their life cycle, the MedStar Georgetown University Hospital Headache Center educates women about how migraine may affect them as they move through their life and offers a comprehensive approach to treatment options to help relieve the effects of migraine headaches.
“Migraine is a serious, life-long, and debilitating condition for many women,” said Katherine Hamilton, MD, a migraine headache specialist at the MedStar Georgetown University Hospital Headache Center. “We take a personalized approach to working with each patient to manage migraine headaches in ways that are best suited to their goals and lifestyle,” said Hamilton. “Migraine often can improve during pregnancy and after menopause, but spike during menstrual periods and peri-menopause. Understanding how migraine headaches can manifest throughout a women’s life cycle guides our treatment and care.”
By taking a holistic approach to migraine, Dr. Hamilton focuses on how the effects of migraine shift and change over the course of a woman’s life based on hormonal changes and works with women to manage their migraines to minimalize the disruption to their life. This approach provides the opportunity for Dr. Hamilton and the MedStar Georgetown Headache Center team to use advances in migraine care that can include counseling services, diagnostic testing, peripheral nerve blocks, and other novel treatments, nutrition counseling, stress management, and physical therapy – as opposed to a more traditional approach of just medication. The team also provides patients with access to clinical trials that help advance new, cutting-edge treatments for migraine.
Migraine is a complex disease of the brain involving dysregulation and hyperexcitability of various brain regions, release of inflammatory molecules, blood vessel dilation, and activation of pain-sensing nerves around the head, and one of the most common conditions treated by the team at the MedStar Georgetown Headache Center. A migraine headache tends to be more severe than a normal headache, and it is often accompanied by throbbing on one side of the head. During a migraine attack, patients can sometimes experience symptoms such as dizziness, light sensitivity, and nausea.
The cost of migraine
According to a study by The Journal of Headache and Pain , migraine is the leading cause of workdays lost due to disability in the world among people under age 50. The study found that when employees come to work with a migraine headache, they are responsible for more economic loss than they would have been if they had taken time off during the period in which they are affected by migraine. The number of the days when work efficiency was reduced to less than half due to headache were significantly higher in employees with migraine than in employees with milder, stress-related headaches. The annual economic loss per person due to absenteeism was also higher in employees with migraine compared to those milder headaches. According to the Centers for Disease Control and Prevention , among patients with migraines in the United States, more than half reported severe impairment in activity, the need for bed rest, and/or reduced work or school productivity due to migraines. As an active part of the workforce, women are most effected by migraine during their peak productive years, so the measured impact of migraine on overall production may be greater if the disease is not well controlled. Compared with men, women were younger (46.1 vs 42.0 years; P < .001); had more Migraine Headache Days (5.6 vs 5.3; P < .001); and were more likely to report moderate or severe headache-related disability (45.9% vs 35.8%; P < .001) and cutaneous allodynia (43.7% vs 29.5%; P < .001). (Lipton et al., 2018)
There is also a possibility that severe headaches could be a sign of other medical conditions, especially when a patient experiences new symptoms such as aura (sensations such as seeing flashing lights or zigzag lines) or mental exhaustion. Patients over age 50 who start to get headaches for the first time may be at risk for certain types of headache-causing infections or even cancer.
Migraine throughout the life cycle
Because experts know that migraine can often change around the time that women experience hormonal shifts – menstrual period, pregnancy, perimenopause, post-menopause -- the MedStar Georgetown team is able to tailor treatment recommendations when a woman experiences migraine headache.
“We know that estrogen plays a significant role in hormonally-triggered migraine, so using treatments such as estrogen-containing birth control may help to treat migraine,” said Hamilton. “But we also know that there are other triggers for migraine that require different treatment than estrogen control. That’s where our team makes a difference in women’s lives -- by offering the many support services that can comprehensively address what could be several or many causes of migraine. As part of an academic medical center, our team also participates in clinical trials for newer, even more targeted migraine treatments, which patients can enroll in to widen their treatment options.”
Migraine and pregnancy
“Planning ahead for pregnancy is key when it comes to treating migraine. I always ask my female patients whether they have any plans for pregnancy in the next six months, because I want to know well in advance so that we can come up with strategies and plans,” said Hamilton. “The good news is that, for many women, migraine gets better in pregnancy, and this is because they’re not having those hormonal fluctuations that come around the period. However, for women who still experience migraine during pregnancy, our clinic offers safe treatment options, including some non-medication treatments, which can help to ensure women that their options for treatment are not limited during their pregnancy.”
The MedStar Georgetown Headache Center offers procedures like nerve blocks and onabotulinumtoxinA that are safer options for pregnant women, and as-needed medications that have been shown to be safe for pregnant women who are looking for more options beyond generic painkillers for their migraine headaches.
The MedStar Georgetown Headache Center also cares for the treatment of migraine during the postpartum period, a time that can be stressful for women and can trigger additional or more intense migraine headaches. Even if a woman is breastfeeding, there are still more safe treatment options available during this period than during pregnancy.
Migraine and menopause
Approaching menopause is another time of great hormone fluctuation. The Headache Center team counsels women through perimenopause, menopause, and post-menopause, advising them of the potential differences in migraine severity and frequency during each phase. During the peri-menopausal period, the team generally treats migraine similarly to how they would approach a patient with migraine in other stages of their life. Some women also begin preventive medication during this period, in anticipation of their symptoms of migraine potentially becoming more severe. During and after menopause, many women may experience improving symptoms of migraine as their hormones stabilize at low levels and migraine-triggering estrogen fluctuations become less common.
1 – Lipton RB, Bigal ME, Diamond M, et al. AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007 Jan 30;68(5):343-9.
2 – Shimizu, T., Sakai, F., Miyake, H. et al. Disability, quality of life, productivity impairment and employer costs of migraine in the workplace. J Headache Pain 22, 29 (2021). https://doi.org/10.1186/s10194-021-01243-5
3 - QuickStats: Percentage of Adults Who Had a Severe Headache or Migraine in the Past 3 Months, by Sex and Age Group — National Health Interview Survey, United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:359. DOI: http://dx.doi.org/10.15585/mmwr.mm6912a8
4 - Lipton, R. B., Munjal, S., Alam, A., Buse, D. C., Fanning, K. M., Reed, M. L., Schwedt, T. J., & Dodick, D. W. (2018). Migraine in America Symptoms and Treatment (MAST) Study: Baseline Study Methods, Treatment Patterns, and Gender Differences. Headache, 58(9), 1408–1426. https://doi.org/10.1111/head.13407