The document discusses women and migraine, including that migraines are more common in women than men, are influenced by hormone fluctuations, and can be triggered by factors like hormonal changes, stress, foods, weather changes, and sensory stimuli. It covers the epidemiology, pathophysiology, genetics, role of hormones, complications, treatment including medications and lifestyle changes, and prevention of migraines in women.

1. WOMEN

2. PRESENTED BY
SOWMYA KONDLA
13GD1R0017
IV-I B.PHARMACY
UNDER THE GUIDANCE OF
Mr. P. KISHORE KUMAR
(Assistant Professor)
CHILKUR BALAJI COLLEGE OF PHARMACY
(Affiliated to JNTU, Hyderabad, Aziz Nagar, Moinabad,
Telangana -500085)

3.  INTRODUCTION
 EPIDEMIOLOGY
 PATHOPHYSIOLOGY
 GENETICS AND MIGRAINE
 ROLE OF HORMONES IN MIGRAINE
 MIGRAINE TRIGGERING FACTORS
 COMPLICATIONS
 TREATMENT
 PREVENTION
 CONCLUSION
 REFERENCES
CONTENTS

4. INTRODUCTION
 Migraine is a common, chronic, predominantly female
neurovascular disorder.
 Painful cases of headaches are recorded by ancient Egyptians
earlier before 1200 B.C.
 It is characterized by vascular headaches ranges from moderate to
severe of about 4 to 72 hours.
 It can be inherited or by external stress factors like stress, certain
food, weather changes, smoke, fatigue, etc.
 Migrainuers have often have colder hands and feet, the
prevalence of motion sickness is much higher in most of the
migrainuers.

5. AURA AND PAIN

6. CLASSIFICATION OF MIGRAINE
1. CLASSIC MIGRAINE (OR) MIGRAINE WITH AURA
 Classic Migraine is a genetic neurological disease. These early symptoms
are also called as Prodome.
 Typical aura consists of visual or sensory or speech
symptoms.
 It’s occurrence is based on genetics and overweight.
2. COMMON MIGRAINE (OR) MIGRAINE WITHOUT AURA
 It is usually associated with nausea, vomiting, sensitivity to light, etc., with
severe headache.
 It last for 4 to 72 hours with moderate or severe intensity, aggravation by
physical activity and associated with photophobia and phonophobia.

7. OTHER TYPES OF MIGRAINE
 Facial migraine (or) Lower-half headache.
 Status Migrainosus, lasts for more than 72 hours.
 Basilar artery migraine, include visual disturbances, giddiness, loss of
balance, slurred speech, etc.
 Hemiplegic migraine, resembles as stroke and arm or leg is completely
paralyzed for few hours.
 Opthalmoplegic migraine, is complete paralysis of eyes move out of
alignment.

8. SIGNS &
SYMPTOMS
Migraine with aura may have some of the following
sensory symptoms.
 Seeing flashing lights and floating lines.
 Developing temporary peripheral blindness, numbness
or tingling in the face or hands.
 Distorted sense of smell, taste, touch, mental confusion.
 Migraine without aura will not have sensory symptoms.

9.  Worldwide, migraines affect nearly
15% or approximately one billion
people.
 It is more common in women (19%)
than men(11%).
 Rates of migraines are slightly lower
in Asia and Africa.
 In United states women(18%) and men(6%) get migraine
every year.
 Europe migraines affect 12-28% of people yearly.
 Migraines most commonly start between 15 and 24 years of
age and occur more frequently in those 35 to 45 years of
age.
EPIDEMIOLOGY

10. PATHOPHYSIOLOGY

11. Is assumed that following process underlie the occurrence
of the migraine
1. Cortical Spreading Depression (CSD)
2. Activation of Trigeminal Vascular System
3. Sensitization of Peripheral and Central areas of brain

12. GENETICS AND MIGRAINE
Transmission of migraine from parents to children has been reported
early as 17th century with positive family history.
 Serotonin Theory
It states that during migraine headache there is a decrease in
platelet serotonin theory which cause Trigeminal system to release
pain mediating neuropeptides.
 Hypothyroidism
Low functioning thyroid glands are one of the causes of migraine
attacks. Slowed metabolism and circulation seen in hypothyroidism
leads to the retention of water, mucin which cause blood vessels
and tissues in brain to swell and cause pain.

13. ROLE OF HORMONES IN MIGRAINE
 CHANGES IN ESTROGEN

14. MENSTRUAL MIGRAINE

15. MIGRAINE TRIGGERING FACTORS
 Hormonal changes, mainly drop in estrogen levels.
 If parents have migraine.
 Skipping meals or fasting, alcohol, aged cheeses, salty foods and
processed foods.
 Sensory stimuli like bright lights, sun glare, loud sounds. Unusual
smells include perfume, etc.
 A change of weather or the barometric pressure can prompt
migraine.

16. COMPLICATIONS
According to the IHS, there are five complications of migraines.
1. Chronic migraines are daily headaches and mild.
2. Status Migrainosus continues for more than 72 hours.
3. Persistent aura includes symptoms like loss of vision and tinnitus.
4. During the migraine with aura, a patient also has a stroke in the
area of the brain.
5. A migraine seizure is an epileptic seizure that follows a migraine
with aura.

17. TREATMENT
PAIN RELIEVING MEDICATIONS
• This include NSAIDS, triptans, ergot alkaloids, anti- emetics, opiods,
glucocorticoids, Aspirin.
• Drugs marketed specifically for migraines, such as the combination of
Acetaminophen, aspirin and caffeine.
PROPHYLAXIS
• It reduces the frequency, duration and intensity of migraines.
Ex: Naproxen (500mg twice daily)
Mefenamic acid (500mg thrice daily)

18. SUPPLEMENTS
• Magnesium supplements reduce migraine, as Magnesium levels in the brain are low during
migraines. Taken in a dose of 360mg daily.
• Vitamin E, in dose of 400 IU daily for 5 days.
ESTROGEN THERAPY
• Hormonal replacement therapy is medical treatment in surgically perimenopausal, menopausal
and postmenopausal women.
• Its goal is to mitigate caused by diminished circulating estrogen and progesterone hormones
in menopause.

19. TRIPTANS
Effective regimens are Sumatriptan(25mg, 3/day), Naratriptan (1mg, 2/day)
Fravatriptan (2.5mg, 2/day) and Zolmatriptan (2.5mg 2/day).

20. PREVENTION
• Preventive treatments of migraine include medications, nutritional supplements,
lifestyle alterations and surgery.
• Prevention is recommended in those who have headaches more than two days
a week, cannot tolerate the medications used to treat acute attacks, or those with
severe migraine attacks.
• Medications include anti- hypertensive's like beta-blockers, calcium channel blockers,
anti-depressants like gabapentin, valproic acid, topiramate and anti-histamines like
diphenhydramine and cyproheptadine.

21. CONCLUSION
 Prevalence of migraine is more in women due to fluctuations in the female hormone
estrogen levels.
 The use of hormonal replacement therapy, combined oral contraceptives will improve
the migraineur condition.
 So, while diagnosing and prescribing drugs to treat migraine in women, hormone levels
should be carefully monitored.
 In future, research should be focused on estrogen related pathophysiology and
treatment studies in female migraineurs.

22. REFERENCES
1. Indian journal of pharmacology and toxicology, 17 (1) 2016, 27-36.
2. Victor TW, Hu X, Campbell JC, et al. Migraine prevalence by age and sex in
the US. Cephalgia 2010;30:1065-1072.
3. Lay CL, Broner SW. Migraine in women. NeurolClin. 2009;27;503-511.
4. Macgregor EA. Estrogen and attacks of migraine with and without aura.
Lancet Neurol. 2004;3;354-361.