This article is sponsored by Biohaven Pharmaceuticals.
While everyone has dealt with a headache at some time in their life, a migraine is more than “just a headache.” This I can say from my own experience is true. As a headache specialist with a foundation in family medicine for 22 years, I know firsthand how the debilitating symptoms of migraine can wreak havoc on a person’s life, especially if not diagnosed and treated properly.
Countless patients – women and men – have told me their headache and migraine stories during my 30+ years of practice. Many of these patients, mostly women, have tearfully shared their experiences about missing out on important milestones or tiptoeing through life. These include interrupting their education, career, and sometimes even putting their life on hold due to migraine. A mother once told me of her kids’ drawings showing her lying in bed and how she had missed numerous school performances. Another woman was so distraught about having a migraine attack on her wedding day she was thinking of canceling it. Unfortunately, these stories are common.
A common neurological disease and major health issue for women
The numbers are staggering. Migraine affects nearly 40 million Americans and over one billion people around the world. Yet, despite being among the most debilitating diseases, the stigma around migraine exists. Many still downplay its seriousness as “just a headache.”
Additionally, migraine in women is a major health issue that deserves special attention. Migraine is three times more common in women than in men with hormonal fluctuation being a common trigger. The time in a woman’s life when migraine is most likely to occur – her 20s through her early 50s – represents her peak career-earning and child-rearing years. The associated disability from migraine during these critical years can exert a significant financial and emotional toll.
Deconstructing the complexity of migraine
Why does migraine often get misdiagnosed? One reason could be due to its complexity. It is made up of four distinct phases — though not everyone experiences each one. The first phase is prodrome, or a pre-headache that makes people feel tired, foggy, or sore. This is followed by aura, affecting an estimated one-third of people with migraine who have trouble with their speech, vision, and/or hearing. The third phase is the attack, lasting between four and 72 hours. And finally, postdrome, also known as a migraine hangover, can leave people feeling drained for days.
When an attack strikes, people with migraine can experience severely debilitating symptoms, such as intense throbbing or pulsating headaches, nausea, sensitivity to light, sound, and smell, as well as other sensory disturbances. In addition to hormones, attacks can be triggered by stress, weather, caffeine and alcohol consumption, and lack of sleep.
Contributing to the possible confusion is the fact that migraine is often misdiagnosed as tension or sinus headaches. This can unnecessarily delay an effective migraine treatment plan.
Improving migraine diagnosis and understanding the hormone connection
Overall, research also shows that recurring and disabling headache is likely migraine. A study published in the journal Headache found that 82 percent of participants were determined to have migraine or probable migraine in an analysis of patients initially misdiagnosed with primary headache that was not migraine (e.g., episodic tension-type headaches).
Improving recognition and diagnosis of migraine can be achieved by using simple diagnostic and screening tools. For example, asking just three quick questions about a person’s headache history can be very practical during a primary care consultation. These include: 1) Has a headache limited your activities for a day or more in the last three months? 2) Are you nauseated or sick to your stomach? 3) Does light bother you? It is helpful that migraine is a clinical diagnosis and not, for example, a diagnosis driven by labs or imaging.
In addition, understanding the hormone connection is key to helping women better manage their disease. A 2021 National Headache Foundation survey found nearly half of women with migraine disease say hormonal changes related to their period, menopause, or childbirth triggered or made an attack worse. And about 60 percent of women with migraine disease have a hormonal connection between their headaches and their menstrual cycles. This happens whenever a woman’s estrogen and progesterone levels change, leading to what’s called menstrual migraine or menstrually-related migraine.
Primary care doctors play a critical role in migraine management.
Primary care doctors can play a critical role in migraine management. Many people with migraine seek care from their primary care doctor first, as opposed to a neurologist or headache specialist. It is among the top 10 reasons patients visit their primary care doctor and is more common than asthma and diabetes combined globally. TThat’swhy establishing a collaborative patient-doctor relationship to devise an individualized treatment plan at the outset is key. Understanding a person’s family history, exploring what triggers an attack, such as hormone oscillation in women, and identifying migraine symptoms should be an essential part of this interaction.
The good news is that several recent treatment advances are making a real difference for millions of people, helping women, in particular, take control over migraine and their lives. Treatment options include acute treatments taken upon the first symptom of an attack and preventive treatments that can help lessen the frequency and or severity of attacks. One innovative approach, Nurtec® ODT (rimegepant), is the first and only medication that treats and prevents migraine attacks. With this two-in-one approach, treating migraine by primary care doctors could become more common, ultimately changing the treatment paradigm. Practically tailored for use in the primary care setting, Nurtec ODT provides convenient, single-dose efficacy with rapid and sustained relief, a demonstrated safety profile, and broad patient access.
The bottom line is that migraine is the most common neurological disease that primary care doctors will see in their practice, and it affects women disproportionately more than men. We have a real opportunity here with increased awareness, the right diagnosis, and effective treatment approaches. As doctors, we can do our part to help women with migraine get back to engaging more fully in their lives.
Nurtec® ODT 75 mg orally disintegrating tablets is a prescription medicine for the acute treatment of migraine attacks and the preventive treatment of episodic migraine in adults. Do not take it if you are allergic to Nurtec ODT or any of its ingredients. The most common side effects were nausea (2.7 percent) and stomach pain/indigestion (2.4 percent). Please visit Nurtec.com for full Prescribing Information, Patient Information and Important Safety Information.
Susan Hutchinson is a family physician, headache specialist, board-certified family practice physician, and founder, Orange County Migraine & Headache Center. She blogs at Heads Up! Blog and is author of The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to Find Hope and Wellness.
Image credit: Shutterstock.com