Empowering Primary Care in Migraine Management for Women: Bert B. Vargas, MD, FAHS, FAAN

WATCH TIME: 4 minutes

“One contributor is the hormonal differences that women experience that many men do not, which lead them to be more susceptible to migraine attacks during particular times of their cycle. You also see some differences in how women with migraine experience their attacks, or sometimes even get relief from attacks during different periods in pregnancy, or notice a decrease in the number of their migraine attacks even after menopause.”

Women are more prone to migraine as the condition is associated with several stages of the reproductive cycle including menarche, menstruation, pregnancy, and menopause. Also, the use of hormonal contraceptives and hormone replacement therapy can influence the occurrence of migraine. The onset of migraine occurs following menarche, with an increased risk of frequency around the days leading up to and during menstruation. Despite the increased risk of migraine during menstruation, research shows that they tend to have fewer migraine attacks during pregnancy and menopause because of changes in estrogen levels.¹

Furthermore, women who are introduced to external hormones could be at risk for exacerbated migraine as well as potentially elevated vascular issues. Studies note that migraine with aura is a a contributing factor to the risk of stroke, heart disease, and vascular-related mortality.¹ Other research shows that providing women with migraine combined oral contraceptives could also amplify the susceptibility to ischemic stroke and thus, careful consideration is advised for prescriptions.

Recently, Bert B. Vargas, MD, FAHS, FAAN, associate vice president of neuroscience, US Medical Affairs, Eli Lilly, sat down in an interview with NeurologyLive® to discuss how migraine affects women. He talked about how hormonal differences contribute to the higher prevalence of migraine among women, particularly during specific stages in their lives. He also spoke about the primary challenges in accessing headache specialists for migraine treatment and diagnosis. In addition, Vargas explained how primary care providers can effectively manage migraine cases, and when patients should be referred to headache specialists.

REFERENCES
1. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13(3):177-189. doi:10.1007/s10194-012-0424-y