Migraines in Middle Age—Prevention and Pain Management

You’ve experienced the hot flashes, night sweats, and brain fog; dealt with insomnia, fatigue and weight gain. Just when you thought you were getting the hang of middle age with all of its hormone changes, blinding pain strikes without warning.

According to national statistics, approximately 12% of Americans suffer from migraine headaches. This little understood complex neurological condition affects nearly one billion people worldwide and ranks high on the pain scale for headache.[6]

How Migraines are Different

Nearly everyone on the planet has experienced a headache at one time or another. In fact, headaches are the most common type of pain across the globe, and the most common reason for absence from work or school. Many types of headaches exist, with varying levels of pain associated. These include tension headaches, cluster headaches, vascular headaches, sinus headaches and migraines. Headaches may occur in response to stress, infection, head trauma, disease, allergies, neck strain or eyestrain, lack of sleep, dental problems, hormones, or anxiety.[1]

While each type of headache can be incredibly painful, migraines may include other accompanying symptoms as well.

A migraine headache can be described as intense throbbing or pulsing in one area of the head for a period that can last up to 72 hours. Some individuals experience an aura of flashing lights or zig-zag lines directly before or during a migraine headache episode.

Medical research finds that migraine headaches are likely triggered by activity deep within the brain, when inflammatory substances are released surrounding blood vessels around the nerves in the brain and head.

Migraine headaches may also be accompanied by a number of different symptoms. These include:

• Nausea
• Vomiting
• Sensitivity to light
• Sensitivity to sound
• Temporary visual disturbances such as flashing lights or zig-zag patterns
• Temporary loss of vision (blind spots)
• Sensitivity to odors
• Fatigue
• Weakness[2]

Who Gets Migraines?

Statistically speaking, women are three times more likely to suffer from migraine headaches than men.

While migraines do occur in both sexes, about 43% of sufferers are women, while 18% are men.[5]

The reason for the gender gap in migraine sufferers may be hormonal. The menopausal transition is a time of great change for a woman. Where ovaries once created and released estrogen and progesterone to maintain the reproductive system, hormone production has slowly ground to a halt. Within the early stages of menopause, known as perimenopause, migraines may occur as a result of fluctuating hormone levels. Fortunately, these tend to peak out towards the end of the menopause transition. This is particularly true for women who’ve experienced premenstrual stress disorder during the menstrual years.[3]

A wide body of research supports the fact that a hormonal connection regarding both the timing and the frequency of migraine attacks exists. In one study alone, as much as 29% of women reported having migraines associated with menopause.[5]

Individuals are more likely to suffer from migraine headaches if they (are)

• Female
• Have a close family member who suffers from migraines
• Diagnosed with depression, epilepsy, anxiety, bipolar disorder, sleep disorders
• Using oral contraceptives

Sensitive to:

• Strong odors
• Weather change
• Noisy environments
• Tobacco smoke
• Alcohol
• Motion
• Bright/flashing light
• Stress
• Missed doses of certain medications
• Missed meals
• Caffeine or lack of caffeine
• Chocolate
• Aged cheeses[6]

*You can also get migraines if you are a child, male, beyond the age of menopause/andropause, or as a side effect of surgical menopause.

Men, Migraines and Andropause (Male Menopause)

While women are much more likely to suffer from migraines due to hormonal changes, men get migraine headaches too. For them, the hormone connection is not quite as clear however. There is some current research that may link low testosterone levels with migraines in men, but more studies must be done. By the time a man reaches the age of 50 in midlife, testosterone levels have decreased by about 1% a year for 30 years. And while women experience a sharp decline in hormone levels in a relatively short amount of time, men lose testosterone much more gradually. This may make it more difficult to pinpoint the actual causes of some medical conditions such as migraine headaches.[6]

Who’s At Risk?

Men who’ve played high contact sports, or served in the military appear to be at greater risk for migraine headaches. This has been linked to concussions sustained (even while younger) as well as TBI (Traumatic Brain Injury) or PTSD (Post Traumatic Stress Disorder) as a result of military engagement.

Interesting to note, that when asked about possible reasons for migraine headaches, 35% of men reported that their migraine was due to some type of physical overexertion. Women were much more likely to cite changes in weather and stress.[6]

Treatment Options for Migraines

Treatment options for both men and women vary depending on the severity of headaches, frequency, duration and cause. Some individuals who suffer from migraines in midlife will respond favorably with over-the-counter medications and rest. Other individuals may need more serious medical intervention to alleviate symptoms or address a hormone imbalance. Treating migraine headaches throughout menopause or andropause may include a combination of pharmaceutical interventions, hormone therapies, lifestyle changes, and complementary approaches.[2]

Migraine treatment for both men and women generally involves one of two approaches: migraine prevention or migraine treatment for pain. While there is no 100% cure for migraine headaches related to hormonal changes, there are several treatment options available.

Migraine Prevention Therapies

These include pharmaceuticals originally created for other medical conditions such as epilepsy, depression, or high blood pressure. Botulinum toxin, (BOTOX) has proven to be very effective in prevention of migraine headaches as well.

General practitioners or neurologists also prescribe pharmaceuticals for migraine prevention. These work to create conditions in the body so migraines do not occur at all.

Medications include:

• Anticonvulsants
• Antidepressants
• Antihistamines
• Beta-blockers
• Botulinum toxin
• Calcium channel blockers
• Histamine

Pharmaceuticals for Migraine Pain

Medication for pain may include one or more of the following pharmaceuticals:
Over-the-counter medication such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). These may be offered in combination with caffeine and aspirin as well.
Triptans that act as serotonin receptor agonists may be prescribed for migraine pain.
Ergotamine derivatives may be used as well.[4]

Natural Treatment for Migraine Headaches

Many behavior modification therapies and lifestyle changes are effective in preventing and treating migraine headaches.

These include:

• Exercise
• Meditation
• Yoga
• Biofeedback
• Dietary changes
• Eating at specific times throughout the day
• Hydration (if dehydrated)
• Consistent bedtime and waking
• Reducing or stopping certain medications
• Nutrition supplements

There is no need to suffer in silence with migraine headaches linked to hormonal changes in midlife. By eliminating possible migraine triggers and practicing healthy behaviors that include exercise, good consistent sleep, and stress reduction you may be able to successfully prevent or reduce the frequency or duration of migraine headaches. For more serious or chronic headache conditions it is important to consult with a medical professional for proper diagnosis and treatment.