by Cristina Marrone
Migraines are three times more common among young women than men due to hormonal fluctuations. Stress and sleep also impact. The new therapies available
According to the World Health Organization, migraine represents one of the most debilitating diseases with important repercussions on the personal, social, working and emotional lives of patients who suffer from it with important costs that countries have to face (from 18 to 27 billion in Europe) . Approximately 1 billion people suffer from migraines in the world (12% of the world population) and in Italy alone the disorder affects six million citizens, with a clear predilection for young-adults and women.
One of the main types of headache is migraine and one of the most common causes of temporary disability among women aged between 15 and 49. Migraine is characterized by pain that often affects the head starting from the temple or forehead. The pain is very intense and pulsating; it is often accompanied by nausea, vomiting, discomfort from light and sounds with episodes that can last from a few hours up to three days. Before puberty, boys and girls are equally likely to suffer from migraines, but once they reach development, migraines become much more common in women. Women have a chance three times more likely to suffer from migraines than men
and this type of headache usually hits women harder around the age of 30-40, a particularly challenging period of life with work, family, children and the consequences of days lost due to debilitating pain are important says Gennaro Bussone, neurologist, founder of the Headache Center of the Besta hospital in Milan. Female migraine – he adds – is the reason why it affects women more who are generally very stressed and pressured by family and work commitments and lead a life with their foot always pressed on the accelerator. the brain that “warns” the woman that she has exceeded the limits with the headache, which becomes a symptom. A study from a few years ago found that Italian women with migraines, compared to their European colleagues, are more likely than others to go to work anyway even if they are unwell. Women also generally have more difficulty sleeping than men and tiredness can cause headaches. However, the main cause of migraines in women is to be found in female sex hormones, and in particular in their fluctuation.
The role of estrogen in migraine
Numerous scientific studies have shown that estrogen plays an important role in the development of migraine. 60-70 percent of patients have attacks related to different times of the cycle, especially immediately before or during menstruation, when estrogen levels drop. The main cause is the periodic, sharp drop in estrogen in this phase which, in women who are very sensitive to hormonal fluctuations, can trigger pain explains Bussone, who was also president of the Italian Neurological Association for Headache Research. Research has not yet clarified why estrogen fluctuations trigger migraines; However, the female hormone performs important activities within the brain (such as improving cerebral blood flow, neuronal connection and the release of neurotransmitters), so hormonal changes could trigger a series of events that then culminate in migraines. Some women may also experience headaches during pregnancy, when there is a drastic change in the hormonal structure; others instead experience a decline in attacks. For many women, menopause is associated with an improvement in migraines because hormonal fluctuations disappear, but for a far from residual number the end of the menstrual cycle becomes a trigger for pain precisely because there is a drastic change in the structure. hormonal. In some women the use of the contraceptive pill can lead to an improvement in migraines, in others the pill (especially older generation) can be worsening. The answers, obviously, are very subjective and each patient may have different triggers for headache attacks: from changing weather to a glass of wine, from lack of sleep to caffeine abuse, from excess physical activity to stress. . Generally the “triggers” are the same ones that trigger tension headache, another type of headache, the most widespread.
In addition to migraines, women are about 1.5 times more likely of men suffer from tension headache, which is the classic headache that everyone experiences sooner or later, characterized by a dull pain that affects in a widespread way, of mild-medium intensity, and therefore bearable but which does not allow you to carry out normal activities daily as you would like. It is not yet clear why tension headaches are more common in women, but stress and anxiety could play a role, as well as subjective triggers. Some studies suggest that this type of headache is more frequent in women in the days close to the menstrual cycle and hormones could also be involved in this case. Other work, however, does not provide evidence that hormones are to blame. Tension headache is the somatized mirror of an emotional state – says Bussone – and to limit migraine and headache attacks, when you are not in the acute phase of pain, you can try experimenting with relaxation techniques, such as mindfulness or pilates. Physical activity can prevent and even cure some headaches, in particular tension headaches which are favored by an unhealthy lifestyle. However, excessive or prolonged efforts should be avoided as they can be counterproductive and cause headaches.
If more than 5-6 episodes of headache occur per month and each episode lasts 1-2 days, the analgesic is no longer enough, but specific therapy is necessary by contacting a Headache Center, suggests the neurologist. Today there are new drugs for prevention therapy that reduce the frequency and severity of attacks and are more effective than traditional therapies, in particular with regard to the side effects that push 8 out of 10 patients to abandon therapy. In Headache Centers, monoclonal antibodies directed against CGRP (peptide related to the calcitonin gene), the protagonist of migraine pain, are available. These treatments are well tolerated, safe and effective: they halve the monthly migraine days in 70% of patients, also reducing the intensity of the crisis. In some patients (10-15%) migraine can be significantly reduced, radically changing the quality of their life, as emerged from the latest National Congress of the Italian Society of Neurology (SIN) which took place last October in Naples. These are very expensive drugs, currently intended only for patients who have failed three previous treatments or who cannot follow traditional therapies or who suffer from chronic migraines. Botulinum toxin has also been shown to be effective in the prevention of chronic migraine, however the protocol requires periodic administration at authorized headache centres. New drugs are also arriving for migraine attacks such as ditans (an advancement of triptans), which act on the serotonin receptor and gepants, which always target the CGRP molecule. Some of these drugs can be used as preventive therapy.
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December 11, 2023 (changed December 11, 2023 | 10:00)
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