SlideShare a Scribd company logo
Women and Migraine
The Prevalence and Diagnosis of Migraine in a
Primary Care Setting –The Landmark Study
Background:
• To determine the prevalence and diagnosis of migraine in
patients presenting to primary care physicians (PCPs) with a
complaint of headache
Study Design:
• Prospective, multi-center, international study
• PCPs from 128 centers in 14 countries recruited 1203 patients
• Recruited patients consulting PCP with complaint of headache
• PCP diagnosed patients via customary practice
• Expert panel made final headache diagnoses for patients with a
new migraine diagnosis or a non-migraine diagnosis (n=377)
Newman et al. Poster presented at: The Diamond Headache Clinical Research and Educational Foundation Meeting; July 16-20,
2002; Lake Buena Vista, Fl.
Patients Presenting with Headache
Most Likely Have Migraine
Of 377 patients who returned diaries:
Newman et al. Poster presented at: The Diamond Headache Clinical Research and Educational Foundation Meeting; July 16-20,
2002; Lake Buena Vista, Fl.
Episodic Tension
Headache
3%
Migrainous
18%
Migraine
76%
Other
3%
Why Women and Migraine?
• Women have Migraine 3:1 compared to
men.
• In peak years (20 – 50) , Migraine affects
25% of women (1 in 4).
• Migraine will affect 40% of women by age
50.
Prevalence of Migraine
Age and Gender
 Peak prevalence at age 40 years
 Greatest impact on ages 25 to 55 years
Lipton RB, et al. Headache. 2001;41:646-657.
0
5
10
15
20
25
30
0 20 30 40 50 60 70 80 90
Age (years)
MigrainePrevalence(%)
Females
Males
Female Life Events That
Influence Migraine
• Menarche
• Menses
• Oral Contraception
• Pregnancy
• Lactation
• Menopause
• Hormone Therapy
Migraine and Menarche
• Females suffer from migraine at a 3:1 ratio to
males
• Beginning with puberty, migraine is more
common in girls
• Menstrually-associated migraine begins at
menarche in 33% of women
• 60-70% of female sufferers experience migraine in
association with menses
MacGregor EA. Neurologic Clinics. 1997;15(1):125-141.
Silberstein SD, Merriam GR. Neurology. 1991;41:786-793.
Benedetto C et al. Cephalalgia. 1997;17(suppl 20):32-34.
Menstrual Migraine: Definitions
• Menstrually-associated migraine (MAM):
– Women who experience attacks that occur both
perimenstrually and at other times of the month
– 60-70% of female migraineurs report a menstrual
relationship to their headaches
– MAM is also referred to as menstrually-related
migraine (MRM)
• Menstrual migraine (MM):
– Women who experience attacks that occur only
perimenstrually
– True menstrual migraine occurs in only 7-14% of
female migraineurs
Benedetto C et al. Cephalalgia. 1997;17(suppl 20):32-34.
Role of Estrogen
• Estrogen is a neuromodulator.
• A decrease in estrogen increases the
Trigeminal mechano- receptor field which
in turn increases pain perception and
increases cerebral vasoreactivity to
serotonin.
Role of Estrogen
• In other words, a decrease in
estrogen can precipitate migraine.
Hormone Levels During Menstrual Cycle
Adapted from Hatcher RA, Trussell J, Stewart, F. Contraceptive Tecnhology, 17th Revised Ed.
New York, NY. Ardent Media, Inc. 1998:Appendix, Figure 2.
HORMONAL FLUCTUATIONS DURING THE MENSTRUAL CYCLE
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Day of Cycle (day 0 is start of blood flow)
HormoneLevelsThroughoutCycle Follicular Phase Luteal Phase
Endocrine
Cycle
LH
FSH
E2
POvulation
Treatment of Menstrual Migraine
• Symptomatic
• Prophylactic
• Hormonal Manipulation
Migraine and
Oral Contraceptives
Migraine and Oral Contraception
• Concerning migraine, 1/3 stay same, 1/3
improve, and 1/3 worsen.
• Triphasic preparations may make migraine
worse due to fluctuating levels.
• Lowest dose of estrogen best for migraine.
• Progesterone only pills do not affect
migraine.
Migraine and Oral Contraception
• Biggest risk of migraine is during hormone
free period.
• Newer preparations like Nuvaring may be
better due to constant low dose estrogen
release.
Migraine and Oral Contraception
• New or persistent Headache
• New onset of migraine with aura.
• Prolonged aura
Red Flags
Migraine and Oral Contraception
• Risk of stroke in healthy female <45 is 5-10 / 100,000.
• Odds ratio(OR) with any migraine – 3
• OR with migraine with aura – 6
• OR with migraine and OC – 5 – 17 (migraine with aura
higher end)
• OR with migraine, smoking, and OC - 34
Risk of Stroke
Migraine During
Pregnancy
Impact of Pregnancy on Migraine
• 60-70% improvement in the frequency of
migraines, particularly in the 2nd and 3rd
trimesters
• 4-8% of women experience worsening of
symptoms
• Approximately 10% of migraine cases start
during pregnancy
• Pre-pregnancy headache pattern returns almost
immediately postpartum
• Independent of migraine type
Aube M. Neurology. 1999;53(S1):S26-S28.
Treatment of Migraine during
Pregnancy
• Treatment is challenging due to risk to
baby.
• Magnesium, B2, and CoQ10 are probably
safe.
• Otherwise need to weigh benefits vs risks.
Migraine and Lactation
Migraine and Lactation
• Generally medications safe during
pregnancy are safe during lactation.
• Notable exceptions are Benadryl and
Cyproheptadine.
• Triptans are still recommended to pump and
dump.
Migraine and
Menopause
Migraine and Menopause
• Preexisting Migraine
– improves - 8% - 36%
– worsens - 9% - 42%
– unchanged - 27% - 64%
• New Migraine may develop in 8% - 13%
Migraine and Menopause
• In perimenopause, headaches may be worse
due to fluctuating hormone levels.
Migraine and Hormone
Replacement Therapy
Migraine and HRT
• Migraines improved - 22%
• Migraines worsened - 21%
• Migraines unchanged - 57%
– migraines likely to be unchanged if natural
menopause had no effect on them
Hodson et al /2000
Update on Migraine
Chronic Daily Headache
• Typically is a bilateral, constant headache
which occurs nearly daily
• Can fluctuate in intensity and at times have
characteristics of migraine
• Are frequently “transformed migraine”
Update on Migraine
Chronic Daily Headache
• Typically associated with taking analgesic
medication on a daily basis (medication overuse
headache)
– acetaminophen, Excedrin, ibuprofen, butalbital,
Midrin, narcotics, and even the 5HT 1b/1d agonists
• Prophylactic medication will not work if analgesic
rebound present
Questions?
Dr. Jeffrey Frank, M.D.
Neurologist
Norton Neuroscience Institute
(502) 629-2602

More Related Content

What's hot

MS Disease modifying agents for multiple sclerosis
MS Disease modifying agents for multiple sclerosisMS Disease modifying agents for multiple sclerosis
MS Disease modifying agents for multiple sclerosis
Hossam Sayed
 
Myasthenia gravis
Myasthenia gravisMyasthenia gravis
Myasthenia gravis
Shweta Sharma
 
Multiple Sclerosis and Women's Health 2015
Multiple Sclerosis and Women's Health 2015Multiple Sclerosis and Women's Health 2015
Multiple Sclerosis and Women's Health 2015
Monique Canonico
 
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
PVI, PeerView Institute for Medical Education
 
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
MS Trust
 
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA. Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
Fundación Ramón Areces
 
Dravet syndrome
Dravet syndromeDravet syndrome
Dravet syndrome
ghoshupasana
 
The new treatment paradigm for MS
The new treatment paradigm for MSThe new treatment paradigm for MS
The new treatment paradigm for MS
MS Trust
 
Health and healing for body and mind - 25 July 2016
Health and healing for body and mind - 25 July 2016Health and healing for body and mind - 25 July 2016
Health and healing for body and mind - 25 July 2016
BreaCan
 
Myasthenia gravis during pregnancy
Myasthenia gravis during pregnancyMyasthenia gravis during pregnancy
Myasthenia gravis during pregnancy
Ahmed Alaa
 
Myasthenia gravis in pregnancy
Myasthenia gravis in pregnancyMyasthenia gravis in pregnancy
Myasthenia gravis in pregnancy
Carlos Rene Espino de la Cueva
 
Ha1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021residentHa1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021resident
Monique Canonico
 
What is brain health? - Gavin Giovannoni
What is brain health? - Gavin GiovannoniWhat is brain health? - Gavin Giovannoni
What is brain health? - Gavin Giovannoni
MS Trust
 
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGSFriday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
LGS Foundation
 
Switching DMDs and new pipeline therapies - Dr Eli Silber
Switching DMDs and new pipeline therapies - Dr Eli SilberSwitching DMDs and new pipeline therapies - Dr Eli Silber
Switching DMDs and new pipeline therapies - Dr Eli Silber
MS Trust
 
Mysthenia gravis
Mysthenia gravisMysthenia gravis
Mysthenia gravis
Shivaram
 
Neuroinflammatory msnmonmda resident lecture2020canonico
Neuroinflammatory msnmonmda resident lecture2020canonicoNeuroinflammatory msnmonmda resident lecture2020canonico
Neuroinflammatory msnmonmda resident lecture2020canonico
Monique Canonico
 
oral drugs in multiple sclerosis
oral drugs in multiple sclerosisoral drugs in multiple sclerosis
oral drugs in multiple sclerosis
Neurology resident slides
 
Dravet Syndrome
Dravet SyndromeDravet Syndrome
Dravet Syndrome
Ade Wijaya
 
Diagnosis of MS and related disorders in children - Cheryl Hemingway
Diagnosis of MS and related disorders in children - Cheryl HemingwayDiagnosis of MS and related disorders in children - Cheryl Hemingway
Diagnosis of MS and related disorders in children - Cheryl Hemingway
MS Trust
 

What's hot (20)

MS Disease modifying agents for multiple sclerosis
MS Disease modifying agents for multiple sclerosisMS Disease modifying agents for multiple sclerosis
MS Disease modifying agents for multiple sclerosis
 
Myasthenia gravis
Myasthenia gravisMyasthenia gravis
Myasthenia gravis
 
Multiple Sclerosis and Women's Health 2015
Multiple Sclerosis and Women's Health 2015Multiple Sclerosis and Women's Health 2015
Multiple Sclerosis and Women's Health 2015
 
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcomin...
 
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
Sequencing of Disease Modifying Treatments in Multiple Sclerosis - Belinda We...
 
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA. Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
Dennis Rosen - Harvard Medical School and Boston Children's Hospital, USA.
 
Dravet syndrome
Dravet syndromeDravet syndrome
Dravet syndrome
 
The new treatment paradigm for MS
The new treatment paradigm for MSThe new treatment paradigm for MS
The new treatment paradigm for MS
 
Health and healing for body and mind - 25 July 2016
Health and healing for body and mind - 25 July 2016Health and healing for body and mind - 25 July 2016
Health and healing for body and mind - 25 July 2016
 
Myasthenia gravis during pregnancy
Myasthenia gravis during pregnancyMyasthenia gravis during pregnancy
Myasthenia gravis during pregnancy
 
Myasthenia gravis in pregnancy
Myasthenia gravis in pregnancyMyasthenia gravis in pregnancy
Myasthenia gravis in pregnancy
 
Ha1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021residentHa1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021resident
 
What is brain health? - Gavin Giovannoni
What is brain health? - Gavin GiovannoniWhat is brain health? - Gavin Giovannoni
What is brain health? - Gavin Giovannoni
 
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGSFriday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
Friday Morning 10-24-14 Dr. Wheless Clinical Practice of LGS
 
Switching DMDs and new pipeline therapies - Dr Eli Silber
Switching DMDs and new pipeline therapies - Dr Eli SilberSwitching DMDs and new pipeline therapies - Dr Eli Silber
Switching DMDs and new pipeline therapies - Dr Eli Silber
 
Mysthenia gravis
Mysthenia gravisMysthenia gravis
Mysthenia gravis
 
Neuroinflammatory msnmonmda resident lecture2020canonico
Neuroinflammatory msnmonmda resident lecture2020canonicoNeuroinflammatory msnmonmda resident lecture2020canonico
Neuroinflammatory msnmonmda resident lecture2020canonico
 
oral drugs in multiple sclerosis
oral drugs in multiple sclerosisoral drugs in multiple sclerosis
oral drugs in multiple sclerosis
 
Dravet Syndrome
Dravet SyndromeDravet Syndrome
Dravet Syndrome
 
Diagnosis of MS and related disorders in children - Cheryl Hemingway
Diagnosis of MS and related disorders in children - Cheryl HemingwayDiagnosis of MS and related disorders in children - Cheryl Hemingway
Diagnosis of MS and related disorders in children - Cheryl Hemingway
 

Viewers also liked

Murphy 2 ya got trouble
Murphy 2 ya got troubleMurphy 2 ya got trouble
Murphy 2 ya got trouble
Norton Healthcare
 
Handout evidence based practice update
Handout   evidence based practice updateHandout   evidence based practice update
Handout evidence based practice update
Norton Healthcare
 
Topic 4 Massage Therapy handout
Topic 4 Massage Therapy handoutTopic 4 Massage Therapy handout
Topic 4 Massage Therapy handout
Norton Healthcare
 
Hopkins why kasper
Hopkins why kasperHopkins why kasper
Hopkins why kasper
Norton Healthcare
 
Topic 7 handout herbal supplements
Topic 7 handout   herbal supplementsTopic 7 handout   herbal supplements
Topic 7 handout herbal supplements
Norton Healthcare
 
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural stateDay 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
Norton Healthcare
 
Cupid's Kids
Cupid's Kids Cupid's Kids
Cupid's Kids
Norton Healthcare
 

Viewers also liked (7)

Murphy 2 ya got trouble
Murphy 2 ya got troubleMurphy 2 ya got trouble
Murphy 2 ya got trouble
 
Handout evidence based practice update
Handout   evidence based practice updateHandout   evidence based practice update
Handout evidence based practice update
 
Topic 4 Massage Therapy handout
Topic 4 Massage Therapy handoutTopic 4 Massage Therapy handout
Topic 4 Massage Therapy handout
 
Hopkins why kasper
Hopkins why kasperHopkins why kasper
Hopkins why kasper
 
Topic 7 handout herbal supplements
Topic 7 handout   herbal supplementsTopic 7 handout   herbal supplements
Topic 7 handout herbal supplements
 
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural stateDay 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
Day 2 | CME- Trauma Symposium | Pediatric trauma challenges for a rural state
 
Cupid's Kids
Cupid's Kids Cupid's Kids
Cupid's Kids
 

Similar to Dr. frank june 13 women headaches

Headache and migrane in women
Headache and migrane in womenHeadache and migrane in women
Headache and migrane in women
webzforu
 
Management of Epilepsy in Pregnancy 2020.pptx
Management of Epilepsy in Pregnancy 2020.pptxManagement of Epilepsy in Pregnancy 2020.pptx
Management of Epilepsy in Pregnancy 2020.pptx
SyedFurqan30
 
Noon friedman
Noon friedmanNoon friedman
Noon friedman
plmiami
 
Headache in pregnancy
Headache in pregnancyHeadache in pregnancy
Headache in pregnancy
Mohammad Baghbanian
 
Migraine
MigraineMigraine
Migraine
Shriyans Jain
 
Migraine - focus on recent advances
Migraine - focus on  recent advancesMigraine - focus on  recent advances
Migraine - focus on recent advances
Dr. Samiran Adhikari
 
Course 11 headaches
Course 11  headachesCourse 11  headaches
Course 11 headaches
Nelson Hendler
 
Women with Epilepsy: Role of newer anti-seizure drugs
Women with Epilepsy: Role of newer anti-seizure drugsWomen with Epilepsy: Role of newer anti-seizure drugs
Women with Epilepsy: Role of newer anti-seizure drugs
Pramod Krishnan
 
MIGRAINE
MIGRAINEMIGRAINE
MIGRAINE
Sudhir Kumar
 
Ppt epilepsy woman
Ppt epilepsy womanPpt epilepsy woman
Ppt epilepsy woman
NeurologyKota
 
1. migraine management cme final 2018
1. migraine management cme final 20181. migraine management cme final 2018
1. migraine management cme final 2018
DrArun Kumar
 
1. migraine management cme final 2018
1. migraine management cme final 20181. migraine management cme final 2018
1. migraine management cme final 2018
DrArun Kumar
 
What is migraine march 2013
What is migraine march 2013What is migraine march 2013
What is migraine march 2013
Norton Healthcare
 
Pm 2.15 policar contracept
Pm 2.15 policar contraceptPm 2.15 policar contracept
Pm 2.15 policar contracept
plmiami
 
Migraine and types
Migraine and typesMigraine and types
Migraine and types
Harsh shaH
 
Course 11 headaches of all types
Course 11  headaches of all typesCourse 11  headaches of all types
Course 11 headaches of all types
Nelson Hendler
 
Biofeedback on Pregnant women with Migraines
Biofeedback on Pregnant women with MigrainesBiofeedback on Pregnant women with Migraines
Biofeedback on Pregnant women with Migraines
Shcl1438
 
HEADACHE SLIIDE SHARE.pptx primary headache
HEADACHE SLIIDE SHARE.pptx primary headacheHEADACHE SLIIDE SHARE.pptx primary headache
HEADACHE SLIIDE SHARE.pptx primary headache
ASHISH KUMAR
 
Menopause
MenopauseMenopause
Mpn and fertility
Mpn and fertilityMpn and fertility
Mpn and fertility
Marwa Khalifa
 

Similar to Dr. frank june 13 women headaches (20)

Headache and migrane in women
Headache and migrane in womenHeadache and migrane in women
Headache and migrane in women
 
Management of Epilepsy in Pregnancy 2020.pptx
Management of Epilepsy in Pregnancy 2020.pptxManagement of Epilepsy in Pregnancy 2020.pptx
Management of Epilepsy in Pregnancy 2020.pptx
 
Noon friedman
Noon friedmanNoon friedman
Noon friedman
 
Headache in pregnancy
Headache in pregnancyHeadache in pregnancy
Headache in pregnancy
 
Migraine
MigraineMigraine
Migraine
 
Migraine - focus on recent advances
Migraine - focus on  recent advancesMigraine - focus on  recent advances
Migraine - focus on recent advances
 
Course 11 headaches
Course 11  headachesCourse 11  headaches
Course 11 headaches
 
Women with Epilepsy: Role of newer anti-seizure drugs
Women with Epilepsy: Role of newer anti-seizure drugsWomen with Epilepsy: Role of newer anti-seizure drugs
Women with Epilepsy: Role of newer anti-seizure drugs
 
MIGRAINE
MIGRAINEMIGRAINE
MIGRAINE
 
Ppt epilepsy woman
Ppt epilepsy womanPpt epilepsy woman
Ppt epilepsy woman
 
1. migraine management cme final 2018
1. migraine management cme final 20181. migraine management cme final 2018
1. migraine management cme final 2018
 
1. migraine management cme final 2018
1. migraine management cme final 20181. migraine management cme final 2018
1. migraine management cme final 2018
 
What is migraine march 2013
What is migraine march 2013What is migraine march 2013
What is migraine march 2013
 
Pm 2.15 policar contracept
Pm 2.15 policar contraceptPm 2.15 policar contracept
Pm 2.15 policar contracept
 
Migraine and types
Migraine and typesMigraine and types
Migraine and types
 
Course 11 headaches of all types
Course 11  headaches of all typesCourse 11  headaches of all types
Course 11 headaches of all types
 
Biofeedback on Pregnant women with Migraines
Biofeedback on Pregnant women with MigrainesBiofeedback on Pregnant women with Migraines
Biofeedback on Pregnant women with Migraines
 
HEADACHE SLIIDE SHARE.pptx primary headache
HEADACHE SLIIDE SHARE.pptx primary headacheHEADACHE SLIIDE SHARE.pptx primary headache
HEADACHE SLIIDE SHARE.pptx primary headache
 
Menopause
MenopauseMenopause
Menopause
 
Mpn and fertility
Mpn and fertilityMpn and fertility
Mpn and fertility
 

More from Norton Healthcare

2017 Norton Children’s Hospital NICU & 3N Reunion
2017 Norton Children’s Hospital NICU & 3N Reunion2017 Norton Children’s Hospital NICU & 3N Reunion
2017 Norton Children’s Hospital NICU & 3N Reunion
Norton Healthcare
 
Chili's Clip for Kids Kick-off
Chili's Clip for Kids Kick-offChili's Clip for Kids Kick-off
Chili's Clip for Kids Kick-off
Norton Healthcare
 
Five foods for weight loss
Five foods for weight lossFive foods for weight loss
Five foods for weight loss
Norton Healthcare
 
Which holiday plants are really poisonous?
Which holiday plants are really poisonous?Which holiday plants are really poisonous?
Which holiday plants are really poisonous?
Norton Healthcare
 
National Women's Health & Fitness Day
National Women's Health & Fitness DayNational Women's Health & Fitness Day
National Women's Health & Fitness Day
Norton Healthcare
 
Slideshow: Camp Brave Hearts
Slideshow: Camp Brave HeartsSlideshow: Camp Brave Hearts
Slideshow: Camp Brave Hearts
Norton Healthcare
 
Splashin Fashion | Splash 'n' Dash 5K
Splashin Fashion | Splash 'n' Dash 5KSplashin Fashion | Splash 'n' Dash 5K
Splashin Fashion | Splash 'n' Dash 5K
Norton Healthcare
 
Splashin fashion
Splashin fashionSplashin fashion
Splashin fashion
Norton Healthcare
 
Throwback Thursday: A champ for kids
Throwback Thursday: A champ for kidsThrowback Thursday: A champ for kids
Throwback Thursday: A champ for kids
Norton Healthcare
 
NCI Cancer Survivor Day
NCI Cancer Survivor DayNCI Cancer Survivor Day
NCI Cancer Survivor Day
Norton Healthcare
 
Child Abuse Prevention Awareness Month
Child Abuse Prevention Awareness MonthChild Abuse Prevention Awareness Month
Child Abuse Prevention Awareness Month
Norton Healthcare
 
Topic 3 holistic approach to eating - handout 3 sample menu
Topic 3   holistic approach to eating - handout 3 sample menuTopic 3   holistic approach to eating - handout 3 sample menu
Topic 3 holistic approach to eating - handout 3 sample menu
Norton Healthcare
 
Topic 3 holistic approach to eating presentation handout
Topic 3 holistic approach to eating   presentation handoutTopic 3 holistic approach to eating   presentation handout
Topic 3 holistic approach to eating presentation handout
Norton Healthcare
 
Topic 3 holistic approach to eating handout 2
Topic 3 holistic approach to eating   handout 2Topic 3 holistic approach to eating   handout 2
Topic 3 holistic approach to eating handout 2
Norton Healthcare
 
Topic 3 holistic approach to eating handout 1
Topic 3 holistic approach to eating   handout 1Topic 3 holistic approach to eating   handout 1
Topic 3 holistic approach to eating handout 1
Norton Healthcare
 
Topic 6 handout stress reduction
Topic 6 handout   stress reductionTopic 6 handout   stress reduction
Topic 6 handout stress reduction
Norton Healthcare
 
Topic 5 handout a healing touch
Topic 5 handout   a healing touchTopic 5 handout   a healing touch
Topic 5 handout a healing touch
Norton Healthcare
 
Murphy 1 why treat pain
Murphy 1 why treat painMurphy 1 why treat pain
Murphy 1 why treat pain
Norton Healthcare
 
Mc masters how to apply the statute
Mc masters how to apply the statuteMc masters how to apply the statute
Mc masters how to apply the statute
Norton Healthcare
 
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costichDay 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
Norton Healthcare
 

More from Norton Healthcare (20)

2017 Norton Children’s Hospital NICU & 3N Reunion
2017 Norton Children’s Hospital NICU & 3N Reunion2017 Norton Children’s Hospital NICU & 3N Reunion
2017 Norton Children’s Hospital NICU & 3N Reunion
 
Chili's Clip for Kids Kick-off
Chili's Clip for Kids Kick-offChili's Clip for Kids Kick-off
Chili's Clip for Kids Kick-off
 
Five foods for weight loss
Five foods for weight lossFive foods for weight loss
Five foods for weight loss
 
Which holiday plants are really poisonous?
Which holiday plants are really poisonous?Which holiday plants are really poisonous?
Which holiday plants are really poisonous?
 
National Women's Health & Fitness Day
National Women's Health & Fitness DayNational Women's Health & Fitness Day
National Women's Health & Fitness Day
 
Slideshow: Camp Brave Hearts
Slideshow: Camp Brave HeartsSlideshow: Camp Brave Hearts
Slideshow: Camp Brave Hearts
 
Splashin Fashion | Splash 'n' Dash 5K
Splashin Fashion | Splash 'n' Dash 5KSplashin Fashion | Splash 'n' Dash 5K
Splashin Fashion | Splash 'n' Dash 5K
 
Splashin fashion
Splashin fashionSplashin fashion
Splashin fashion
 
Throwback Thursday: A champ for kids
Throwback Thursday: A champ for kidsThrowback Thursday: A champ for kids
Throwback Thursday: A champ for kids
 
NCI Cancer Survivor Day
NCI Cancer Survivor DayNCI Cancer Survivor Day
NCI Cancer Survivor Day
 
Child Abuse Prevention Awareness Month
Child Abuse Prevention Awareness MonthChild Abuse Prevention Awareness Month
Child Abuse Prevention Awareness Month
 
Topic 3 holistic approach to eating - handout 3 sample menu
Topic 3   holistic approach to eating - handout 3 sample menuTopic 3   holistic approach to eating - handout 3 sample menu
Topic 3 holistic approach to eating - handout 3 sample menu
 
Topic 3 holistic approach to eating presentation handout
Topic 3 holistic approach to eating   presentation handoutTopic 3 holistic approach to eating   presentation handout
Topic 3 holistic approach to eating presentation handout
 
Topic 3 holistic approach to eating handout 2
Topic 3 holistic approach to eating   handout 2Topic 3 holistic approach to eating   handout 2
Topic 3 holistic approach to eating handout 2
 
Topic 3 holistic approach to eating handout 1
Topic 3 holistic approach to eating   handout 1Topic 3 holistic approach to eating   handout 1
Topic 3 holistic approach to eating handout 1
 
Topic 6 handout stress reduction
Topic 6 handout   stress reductionTopic 6 handout   stress reduction
Topic 6 handout stress reduction
 
Topic 5 handout a healing touch
Topic 5 handout   a healing touchTopic 5 handout   a healing touch
Topic 5 handout a healing touch
 
Murphy 1 why treat pain
Murphy 1 why treat painMurphy 1 why treat pain
Murphy 1 why treat pain
 
Mc masters how to apply the statute
Mc masters how to apply the statuteMc masters how to apply the statute
Mc masters how to apply the statute
 
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costichDay 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich
 

Recently uploaded

Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
NX Healthcare
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
Gokuldas Hospital
 
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptxDistrict Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptx
CommunityMedicine46
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
FFragrant
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
Dr. Nikhilkumar Sakle
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
Gokuldas Hospital
 
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptxpharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
AdugnaWari
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
Dr. Dhwani kawedia
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Kanhu Charan
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
Planet Ayurveda
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
NephroTube - Dr.Gawad
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
KerlynIgnacio
 
Breast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapyBreast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapy
Dr. Sumit KUMAR
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdfMedical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Jim Jacob Roy
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Kunj Vihari
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
Jyoti Bhaghasra
 

Recently uploaded (20)

Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
 
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptxDistrict Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptx
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
 
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptxpharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
 
Breast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapyBreast cancer: Post menopausal endocrine therapy
Breast cancer: Post menopausal endocrine therapy
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdfMedical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
 

Dr. frank june 13 women headaches

  • 2.
  • 3. The Prevalence and Diagnosis of Migraine in a Primary Care Setting –The Landmark Study Background: • To determine the prevalence and diagnosis of migraine in patients presenting to primary care physicians (PCPs) with a complaint of headache Study Design: • Prospective, multi-center, international study • PCPs from 128 centers in 14 countries recruited 1203 patients • Recruited patients consulting PCP with complaint of headache • PCP diagnosed patients via customary practice • Expert panel made final headache diagnoses for patients with a new migraine diagnosis or a non-migraine diagnosis (n=377) Newman et al. Poster presented at: The Diamond Headache Clinical Research and Educational Foundation Meeting; July 16-20, 2002; Lake Buena Vista, Fl.
  • 4. Patients Presenting with Headache Most Likely Have Migraine Of 377 patients who returned diaries: Newman et al. Poster presented at: The Diamond Headache Clinical Research and Educational Foundation Meeting; July 16-20, 2002; Lake Buena Vista, Fl. Episodic Tension Headache 3% Migrainous 18% Migraine 76% Other 3%
  • 5. Why Women and Migraine? • Women have Migraine 3:1 compared to men. • In peak years (20 – 50) , Migraine affects 25% of women (1 in 4). • Migraine will affect 40% of women by age 50.
  • 6. Prevalence of Migraine Age and Gender  Peak prevalence at age 40 years  Greatest impact on ages 25 to 55 years Lipton RB, et al. Headache. 2001;41:646-657. 0 5 10 15 20 25 30 0 20 30 40 50 60 70 80 90 Age (years) MigrainePrevalence(%) Females Males
  • 7. Female Life Events That Influence Migraine • Menarche • Menses • Oral Contraception • Pregnancy • Lactation • Menopause • Hormone Therapy
  • 8. Migraine and Menarche • Females suffer from migraine at a 3:1 ratio to males • Beginning with puberty, migraine is more common in girls • Menstrually-associated migraine begins at menarche in 33% of women • 60-70% of female sufferers experience migraine in association with menses MacGregor EA. Neurologic Clinics. 1997;15(1):125-141. Silberstein SD, Merriam GR. Neurology. 1991;41:786-793. Benedetto C et al. Cephalalgia. 1997;17(suppl 20):32-34.
  • 9. Menstrual Migraine: Definitions • Menstrually-associated migraine (MAM): – Women who experience attacks that occur both perimenstrually and at other times of the month – 60-70% of female migraineurs report a menstrual relationship to their headaches – MAM is also referred to as menstrually-related migraine (MRM) • Menstrual migraine (MM): – Women who experience attacks that occur only perimenstrually – True menstrual migraine occurs in only 7-14% of female migraineurs Benedetto C et al. Cephalalgia. 1997;17(suppl 20):32-34.
  • 10. Role of Estrogen • Estrogen is a neuromodulator. • A decrease in estrogen increases the Trigeminal mechano- receptor field which in turn increases pain perception and increases cerebral vasoreactivity to serotonin.
  • 11. Role of Estrogen • In other words, a decrease in estrogen can precipitate migraine.
  • 12. Hormone Levels During Menstrual Cycle Adapted from Hatcher RA, Trussell J, Stewart, F. Contraceptive Tecnhology, 17th Revised Ed. New York, NY. Ardent Media, Inc. 1998:Appendix, Figure 2. HORMONAL FLUCTUATIONS DURING THE MENSTRUAL CYCLE 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 Day of Cycle (day 0 is start of blood flow) HormoneLevelsThroughoutCycle Follicular Phase Luteal Phase Endocrine Cycle LH FSH E2 POvulation
  • 13.
  • 14. Treatment of Menstrual Migraine • Symptomatic • Prophylactic • Hormonal Manipulation
  • 16. Migraine and Oral Contraception • Concerning migraine, 1/3 stay same, 1/3 improve, and 1/3 worsen. • Triphasic preparations may make migraine worse due to fluctuating levels. • Lowest dose of estrogen best for migraine. • Progesterone only pills do not affect migraine.
  • 17. Migraine and Oral Contraception • Biggest risk of migraine is during hormone free period. • Newer preparations like Nuvaring may be better due to constant low dose estrogen release.
  • 18. Migraine and Oral Contraception • New or persistent Headache • New onset of migraine with aura. • Prolonged aura Red Flags
  • 19. Migraine and Oral Contraception • Risk of stroke in healthy female <45 is 5-10 / 100,000. • Odds ratio(OR) with any migraine – 3 • OR with migraine with aura – 6 • OR with migraine and OC – 5 – 17 (migraine with aura higher end) • OR with migraine, smoking, and OC - 34 Risk of Stroke
  • 21. Impact of Pregnancy on Migraine • 60-70% improvement in the frequency of migraines, particularly in the 2nd and 3rd trimesters • 4-8% of women experience worsening of symptoms • Approximately 10% of migraine cases start during pregnancy • Pre-pregnancy headache pattern returns almost immediately postpartum • Independent of migraine type Aube M. Neurology. 1999;53(S1):S26-S28.
  • 22. Treatment of Migraine during Pregnancy • Treatment is challenging due to risk to baby. • Magnesium, B2, and CoQ10 are probably safe. • Otherwise need to weigh benefits vs risks.
  • 24. Migraine and Lactation • Generally medications safe during pregnancy are safe during lactation. • Notable exceptions are Benadryl and Cyproheptadine. • Triptans are still recommended to pump and dump.
  • 26. Migraine and Menopause • Preexisting Migraine – improves - 8% - 36% – worsens - 9% - 42% – unchanged - 27% - 64% • New Migraine may develop in 8% - 13%
  • 27. Migraine and Menopause • In perimenopause, headaches may be worse due to fluctuating hormone levels.
  • 29. Migraine and HRT • Migraines improved - 22% • Migraines worsened - 21% • Migraines unchanged - 57% – migraines likely to be unchanged if natural menopause had no effect on them Hodson et al /2000
  • 30. Update on Migraine Chronic Daily Headache • Typically is a bilateral, constant headache which occurs nearly daily • Can fluctuate in intensity and at times have characteristics of migraine • Are frequently “transformed migraine”
  • 31. Update on Migraine Chronic Daily Headache • Typically associated with taking analgesic medication on a daily basis (medication overuse headache) – acetaminophen, Excedrin, ibuprofen, butalbital, Midrin, narcotics, and even the 5HT 1b/1d agonists • Prophylactic medication will not work if analgesic rebound present
  • 32.
  • 33. Questions? Dr. Jeffrey Frank, M.D. Neurologist Norton Neuroscience Institute (502) 629-2602