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7 September 2006
Mayo Clinic’s Migraine Recommendations 
To help women better understand migraines and provide guidance for sufferers, Mayo Clinic physicians have compiled past study results into a concise summary document, which has just been published in the journal Mayo Clinic Proceedings. Although migraine prevention can be very effective, only 3 to 5 percent of women seek out preventive therapy. "Most people with migraines first seek help from their primary care provider instead of a neurologist or a specialist," says Beverly Tozer, M.D., who led the review. The Mayo Clinic review emphasized preventive therapies for migraines at different stages of a female's life. According to Dr. Tozer, strong evidence suggests that hormonal changes effect migraine development, with migraines being most prevalent during the reproductive years. "Almost one-fourth of women in their reproductive years experience migraines," Dr. Tozer said. "During these years, women are building both their families and their careers. The predominance of this disorder in women with its associated social, functional and economic consequences makes migraine an important issue in women's health." With regard to hormonal causes, the review tracks migraine development and treatment for women from childhood to menopause, and makes the following recommendations. Childhood and Adolescence
In children aged 4 to 7, girls are less likely than boys to have migraines. But by puberty, girls are three times more likely than boys to have migraines. Stress is a major migraine trigger for children and adolescents, and stress management techniques have helped children as young as 8 years. If lifestyle changes fail to reduce migraines, cyproheptadine is a useful medication for children under 6, with several other preventive medications available to older children. Reproductive Years
Migraines increase substantially after a women begins menstruating and menstruation is one of the most common migraine triggers. Menstrual migraines are possibly caused by the decline in estrogen levels before menstruation. Menstrual migraines may be prevented by taking medication only during the vulnerable period when migraines are expected to occur. Medications for prevention include non-steroidal anti-inflammatory drugs, ergots, alkaloids and triptans. In some patients, menstrual migraines also may be managed with hormonal manipulation using oral contraceptives. Pregnancy
Pregnant women with migraines often have fewer attacks by the end of the first trimester. The reviewers emphasized that pregnant women should avoid using medication except in severe cases. If it is determined that the benefits of the preventive therapy outweigh the risks to both mother and fetus, medications such as propranolol hydrochloride, verapamil hydrochloride and topiramate may be used. Menopause
Changing hormone levels make the menopausal transition a challenging time for many women who suffer migraines. The reviewers said that hormonal manipulation and long cycle usage of low-dose oral contraceptives have been useful in managing these migraines. Migraines beginning after age 65 are extremely uncommon and as many as one-third of all headaches in elderly women are due to secondary causes. Doctors recommend lower doses of all preventive medicine for this group to avoid side-effects. Source: Mayo Clinic
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