Migraine in female genital life
Migraine predominates mainly in women in a ratio of three to one. This female predominance can be partly explained by hormones . We have seen in the mechanisms of migraine that the excitability of the hypothalamus could be conditioned by hormonal variations. Thus any period of a woman's life that causes a sudden change in hormones is likely to be a triggering factor for a migraine attack. This is the case of puberty , pregnancy , menopause , but also variations linked to the menstrual cycle .
At puberty
Before puberty, as many girls as boys suffer from headaches. After puberty, about three-quarters of migraine sufferers are women. And for 10 to 20% of women with migraine , their attacks began at puberty . Early puberty could also promote the onset of migraines.
Menstrual migraine
Between 20 and 60% of women with migraine see a link between periods and their attacks .
Pure menstrual migraines are migraine attacks without aura that only occur between D-2 and D+3 of the attack-free cycle in the other phases of the cycle for at least two out of three menstrual cycles. (D+1 being the first day of menstruation). These menstrual headaches may be due to the severe reduction in estrogen levels at the end of the menstrual cycle. Only 10% of migraineurs have a pure menstrual migraine. Although many patients report an increase in their migraine attacks at the time of assessment, no studies have been able to establish the link between ovulation and migraine .
To treat these menstrual migraines, it is recommended to act in the same way as for classic headaches: lie down quietly in a dark room, hydrate... Non-steroidal anti-inflammatory drugs (NSAIDs) or triptans can be taken. Hormonal treatments can also be effective since this type of migraine is linked to the drop in estrogen. This may be, for example, hormonal contraception or estradiol gel or patch.
Migraine and hormonal contraception
Taking oral contraceptives can modify the migraine disease . It could worsen it in 18 to 50% of cases , improve it in 3 to 35% of cases and not modify it in 39 to 65% of cases .
Headaches can start with the taking of oral contraceptives, from the first cycles. Stopping birth control pills does not always bring immediate improvement. It should be noted that estrogen-progestogens are recognized as a risk factor for stroke. The more the pill is dosed, the more the risk increases and it is considered low when the pill contains less than 35 µg of estrogen (or synthetic derivative of estradiol). It is better to orient yourself on the pills of the second and third generation, which are less dosed in estrogen. Migraine is a risk factor for stroke in women under 45 years of age.
This risk doubles if the patient suffers from migraine with aura . Thus the association of tobacco, migraine with aura and oral contraception multiplies by approximately 30 the risk of stroke in young women. It is recommended that all migraine patients with aura favor mechanical contraception and a total absence of tobacco. However, it is important to note that migraine is not a contraindication to oral contraception. In the absence of associated vascular risk factors, the risks remain minimal, approximately 19 per 10,000 migraine patients. It is only recommended to limit the dose of estrogen by favoring progestogen or microdose contraception. Indeed, progestogen contraception is not associated with an increase in vascular risk. Some studies have even reported that it may have a beneficial effect on the frequency of migraine attacks.
In the case of pure menstrual migraines, it is recommended to focus on contraceptives capable of stopping ovulation. This is not the case with progestin-only oral contraceptives. Is it recommended to move towards progesterone injections or implants or oral dydrogesterone. Find out how to relieve migraine naturally
During pregnancy
During pregnancy , migraine attacks, for women prone to these headaches, tend to improve or disappear in 80% of cases . This crisis reduction can be explained by the hormonal stability that the state of pregnancy generates. Indeed, hormonal variations are often the cause of severe headaches. However, for other women who have never experienced a migraine, they may have headaches, particularly at the start of pregnancy. These first trimester headaches are often the result of several changes : blood volume increases, blood pressure fluctuates, hormones are secreted in quantity, fatigue is present…. These are factors conducive to the triggering of crises. To avoid these headaches, future mothers can change certain habits or behaviors that promote headaches (fatigue, coffee, noise, etc.) and prefer rest, calm and relaxation exercises.
Migraine and postpartum
During the postpartum period, many women suffer from headaches: 30 to 40% during the first week postpartum. These are often tension headaches and may be linked to postpartum depression . These migraine attacks can also be explained by the drop in estrogen after childbirth. Some women suffer from headaches right after giving birth. They can be explained by hypoglycaemia following the intense effort that childbirth requires.
And at menopause?
For women with migraine, perimenopause worsens their headaches for 60% of them . This is due to the hormonal changes that take place during this period. After menopause, migraine disease improves in 2/3 of cases. Even after menopause, it remains more common in women than in men: 2.5 women for every man suffer from it after 70 years . To treat headaches in postmenopausal women, migraine treatment is broadly the same as for premenopausal women. However, attention must be paid to the vascular risks of triptans.
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