L. Sandy Hughes, MD, will speak at the November meeting of the East Bay Headache Support Group on the intriguing topic of the relationship between female hormones and headaches.

Dr. Hughes is a practicing OB/GYN physician in Walnut Creek. He grew up in this community, graduating from Ygnacio Valley High School in 1975. He received his undergraduate degree from Stanford University, graduated from medical school at UCLA, and did his residency and OB/GYN at the Harbor UCLA Medical Center in Torrance, CA. A member of the American Society for Reproductive Medicine, Dr. Hughes has a special interest in infertility care and hormone replacement therapy.

We will meet in the Monterey Room, downstairs at John Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, November 11. For more information, call 925-685-8775.

Migraine can strike people of either sex, but it is more common in women. Eighteen percent of women experience migraine, compared with 6% of men.

You can probably blame the gender gap at least partly on female hormones, especially estrogen. Estrogen appears to affect the function of neurotransmitter serotonin. (Neurotransmitters are substances that conduct messages within the nervous system.) Serotonin also seems to influence migraine; when estrogen levels fall, so do serotonin levels—and migraine is more likely.

Another theory is that women with migraine experience alterations in body substances called prostaglandins, prolactin, and opioids.

Learning more about the physiology of migraine can help you understand this condition better.

The incidence and severity of migraine can vary at different times in a woman’s life, as her hormone levels change. She may have more headaches during adolescence. In childhood, the incidence of migraine is similar in boys and girls—but beginning at puberty, it becomes more common in girls as female hormone production revs up at certain times in her menstrual cycle after she’s given birth, during perimenopause (the years leading up to menopause).

On the bright side, many women find their migraines become less severe during pregnancy and after menopause.

Menstrual migraine may begin anytime between the onset of periods and a woman’s early 20s. There are no firm criteria for menstrual migraine, but it seems to have the following characteristics:

Usually there is no aura (the visual or sensory changes that signal a migraine is on its way).

It occurs exclusively during a woman’s period, on day 1 of menstruation or a day or two earlier or later.

It’s thought to be caused by the precipitous drop in estrogen during the luteal phase (second half) of the menstrual cycle.

Although 60% of women with migraine report worsening headache related to menstruation, only 7% to 14% have true menstrual migraine (migraine that occurs ONLY during or right before menstruation). Some women also experience migraine at ovulation (about mid-cycle), when the estrogen level drops.

There’s some argument about whether there’s a true association between premenstrual syndrome (PMS) and menstrual migraine. However, when headache and premenstrual dysphoric disorder (a type of severe, disabling PMS) occur in the same woman, an anti-depressant may manage both disorders successfully.

The impact of birth control pills on migraine is predictable. For some women, migraines improve with pill use. By regulating the menstrual cycle and stabilizing hormonal fluctuations, the pill may reduce headaches.

For other women, the pill worsens migraines—but even among these women, the pattern varies: migraines may be worse the entire month or occur only in the week when a woman isn’t taking active pills. When the pill does have a negative effect on headache, this effect may take up to one year to resolve.

During pregnancy, migraine improves in 70% of women (hurray!)—but in others it can begin, worsen, or remain unchanged.

First trimester of pregnancy: Hormone fluctuations are greatest, and women may continue to have migraines.

Second and third trimesters of pregnancy: Hormone levels stabilize, and migraine tends to improve.

While pregnancy may provide a brief respite from migraine, the headaches usually return after a woman has given birth. Again, changing estrogen levels may be to blame—and, unfortunately, breast-feeding doesn’t protect against migraine.

If you’re experiencing perimenopause, you probably already know that your hormone levels are fluctuating, especially if you’re having symptoms like hot flushes, night sweats, insomnia, or irritability. Those raging hormones can also lead to increased headache activity. And if you’ve undergone surgical menopause (removal of your ovaries), you’re even more likely to find your migraines getting worse.

But once you’re through the perimeno-pausal years and into menopause, your hormone levels will stabilize and chances are you’ll find your migraines improve. In one study of postmenopausal women, migraine improved in 62% remained unchanged in 20%, worsened in 18%.

If you’re perimenopausal and using or considering hormone replacement therapy (HRT), please discuss your migraines with your health care provider. She or he can advise you on what approach is best for you in terms of managing your migraine, perimeno-pausal symptoms and long-term health risks.

Migraine treatment decisions may be affected by a woman’s hormonal status. It’s important to understand why.

A tendency to suffer from migraine is one of those things we seem to inherit. If your mother has migraines, for instance, you’re more likely to get them too. Although the process of migraine is complex and we still don’t know everything about it, we have a general understanding of what initiates a migraine episode and what happens once an episode has been set in motion.

Migraine sufferers appear more likely than other people to experience abnormal levels of certain neurotransmitters, which are message-carrying substances in the brain. This neurotransmitter imbalance affects brain activity, which can start the process of a migraine episode.

An important neurotransmitter involved in migraine is serotonin, and one reason that more women than men suffer from migraine is that the female hormone estrogen affects serotonin levels and activity. When estrogen levels dip, so do serotonin levels—and migraine is more likely when serotonin levels are abnormally low. A drop in estrogen and serotonin occurs shortly before a woman’s period, and that may be why some women tend to suffer from migraine at this time in their menstrual cycle.

Once the process of migraine has begun, the following happens:

Stage 1: Neurons (cells that conduct messages in the nervous system) become hyperexcitable (very active and responsive to stimuli). This hyperexcitability leads to hypoperfusion (decreased blood flow) in the brain. For migraine sufferers who experience an aura (visual or sensory changes) before their headache, the aura will occur at this time.

Stage 2: Neuron activity causes substances called peptides to be released from the trigeminal nerve, an important nerve emerging from the pons (part of the stalk-like part of the lower brain called the brainstem).

Stage 3: These peptides cause dilation (expansion) of blood vessels in the brain and inflammation of nerve endings in the brain.

Stages 4 and 5: This nerve inflammation results in the pain of migraine. Other migraine symptoms can accompany the pain.

It’s important to increase your knowledge of how women’s migraines can be affected by changing hormonal states, such as puberty, the menstrual period, pregnancy and the postpartum period, and menopause. Often we can’t control our hormonal changes, but we can manage environmental and emotional factors that trigger migraine attacks. A head-ache diary will allow you to identify your migraine triggers, and permit you and your doctor to select effective treatment. A knowledge assessment will help you distinguish migraine symptoms from those of tension-type headache. 0

The East Bay Headache Support Group is a nonprofit organization dependent on both monetary donations and volunteer labor. A small group of volunteers organizes the meetings and publishes this newsletter, and our speakers volunteer their time and expertise.

Enclosed is our annual questionnaire. Please complete and mail to Donna Johnson.

Consider making a tax-deductible donation to assist the group with its mission to provide education and support for headache sufferers. And advise if you would like a receipt.

Join the Planning Committee (not a big time commitment).

Write up a personal profile of your struggles and/or successes in dealing with your headaches and submit it for the next newsletter. Can be anonymous.

Suggest a speaker or topic for a support group meeting.

To volunteer, call Leslie Davis at

925-685-8775 or send e-mail to ladavis98@aol.com.

Dr. Alexander Mauskop, although a western doctor, takes an alternative approach to preventing migraine with his “triple therapy program.” The therapy includes 1.) the mineral magnesium, 2.) the vitamin B2 (riboflavin) and 3.) the herb feverfew. Dr. Mauskop pioneered the triple therapy program at the New York Headache Center where he has treated thousands of patients over the past fifteen years.

Dr. Mauskop has been an associate professor of clinical neurology at State University of New York and an attending neurologist at Beth Israel Hospital.

Before discovering this therapy, Dr. Mauskop was prescribing the latest migraine drugs for his patients. He had a busy practice, but he knew the fact that his patients kept coming back to him meant he was helping them, but not curing them. He began to look through the medical literature and talk to his colleagues and his patients. By the early 1990s he was studying magnesium and its role in migraines. Later research led him to add riboflavin (vitamin B2) and the herb feverfew. He was not the first doctor to research each of these ingredients individually for migraine, but he was the first one to put them together as a therapy for preventing migraine.

Dr. Mauskop explains what effect each ingredient produces in the body: magnesium helps keep the blood vessels in the brain properly toned and open, riboflavin is involved in energy generation in each cell in the body, and feverfew helps regulate brain chemistry and quell the inflammation process. The dosages he recommends are: 300-400 mg of magnesium, plus 400 mg of riboflavin, plus 100 mg of feverfew.

You can buy these individually or, very conveniently, you can buy these ingredients combined together in a pill called MigraHealth (or Migralief). In fact, Dr. Mauskop says he has been asked by the makers of MigraHealth to be their spokesman for the product. Actually he tells you this up front, in the author’s note at the beginning of the book. I felt a bit wary at first, but decided that it would be helpful to have the exact formulation that he uses with his patients in order to try it out. They’re available at Wal-Mart for about $15 for 60 caplets, a month’s supply.

The second half of the book provides information that many migraineurs may already be familiar with: the importance of avoiding food and environmental triggers, reducing stress, exercising. And, Dr. Mauskop includes a chapter listing most migraine medicines, explaining how they help as well as their side effects. Finally, there’s a chapter on questions and answers about the Triple Therapy.

I would recommend this book to anyone who would like to try a natural approach to preventing migraine headaches. It may or may not work, but it can’t hurt to try it.