Migraines take a heavy toll on family life at numerous households throughout South Africa, and many of the sufferers are women, writes Dr Elliot Shevel, medical director at The Headache Clinic.
Migraine headaches are under-diagnosed and under-treated, with the result that many South Africans are needlessly struggling with a condition that erodes the quality of their personal and professional lives.
Who gets migraines?
Migraine incidence is highest among both sexes between the age of 25 and 55, the very years that most people are at their economic peak and busiest with the important work of raising a family. The impact on the family and society as a whole is enormous.
One in every four households in the US are affected by the migraines of one its occupants. The numbers for South Africa are likely to be roughly the same as those for the US, since research from around the world indicates that migraines are prevalent in similar proportions across nations, cultures, and races. Among them are millions of women who need to live up to demanding dual roles as homemakers and breadwinners.
Women and migrainesJust about every event in a woman's reproductive development has the potential to change the frequency, severity, or duration of migraine headaches including menarche (the beginning of menstruation at puberty), pregnancy, and menopause.
Women of childbearing age are up to three times as likely to suffer from migraines as men of the same age are. This clearly shows that changes in hormone levels during the menstrual and other hormonal cycles are a major triggering factor of migraines among women. Some 14% of women who suffer from migraines only experience them during or around menstruation, underlining the role played by oestrogen and progesterone withdrawal during the menstrual cycle in migraines among female patients.
A woman who frequently experiences the dull throbbing head pains, nausea and sensitivity to noise and light (all characteristic of migraines) does not suffer on her own. Her condition impacts on her family, too, damaging relationships and often preventing the sufferer from living up to her responsibilities at home.
In one study, 50% of respondents reported that they were more likely to argue with their partners and children because of their migraine while 60% believed that it caused them to be less involved with their partners or children. Their partners confirmed these opinions.
As if the pain of the migraine weren't debilitating enough, migraines are often associated with a broad set of physical, affective and neurological disorders - including complaints such as asthma, chronic fatigue, depression, anxiety and epilepsy. Each of these conditions has the potential to harm the sufferer's home and work life as much as the migraine pains themselves.
What to do about migraines
Migraines do not go away by themselves, and women who neglect to have them treated, run the risk of further health complaints. Recent studies indicate that migraine can be progressive in many patients, which means that the person suffers migraines with increasing frequency over time, until she is in nearly constant pain. This is known as "transformed migraine."
Many patients, not releasing that they suffer from a controllable biological condition that is genetic in origin, begin to rely heavily on over-the-counter and prescription drugs to control their pain. Unfortunately, repetitive and heavy use of these drugs can cause headaches that are even worse than the ones they are supposed to 'cure.'
For these reasons, effective treatment should focus on finding the underlying causes of the patient's pain and providing permanent treatment that prevents progressive migraines and avoids the overuse of medication.
The most important thing to note about menstrual or hormonal migraine is that most women with menstrual migraine have normal hormone levels, so effective treatment needs to focus on finding out why these women have abnormal reactions to normal hormone fluctuations.
The origin of the pain is in physical structures that are located in the head, neck, and facial areas and it is these parts of the body that need to be investigated comprehensively to understand the causes of the migraine. There is no single medical speciality that covers all these parts of the body, which means that a co-ordinated team of medical specialists from a range of disciplines (neurology, maxillo-facial, dentistry, psychiatry/psychology and so on) will often achieve lasting success where a single specialist working in isolation has failed.
The hormonal trigger for migraines should not be treated in isolation as the primary cause of the pain. The trigger may, in conjunction with other investigations therapies, be addressed by hormone replacement therapy in menopausal women or by changing oral contraceptives for younger women. But effective, long-term treatment should focus on co-ordinated treatment of the structures of the head face and neck where the pain originates.
A comprehensive correct diagnosis and successful co-ordinated treatment plan will not only improve the quality of their own lives, but also enhance their relationships with their families.
(Dr Elliot Shevel, The Headache Clinic, September 2005)
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