Adolescence and Adulthood
Before menarche, or first menstruation, girls experience migraine at approximately the same rate as boys. But after puberty hits, female migraineurs outnumber males two to one. And the gap widens into adulthood, where women with migraine exceed men with migraine by three to one.
Given the close association between hormonal changes and migraine incidence and intensity, this phenomenon isn't surprising. The progression of migraine also follows a specific pattern within women that is closely tied to their stage of life and the hormonal changes that accompany these life periods.
Puberty, and specifically, the onset of menstruation, marks the beginning of migraines for many women. Approximately 10 percent of women experience their first migraine at this time of their lives. Some teens who develop migraine without aura in childhood or adolescence will “outgrow” the condition when they reach adulthood; migraine with aura seems to stay with young women (and men) throughout their lifetime.
The physical, social, and emotional changes that take place during adolescence make the added burden of migraine particularly difficult. Adolescence is a time of wanting to fit in, not stand out, and the consequences of dealing with chronic migraine — including withdrawal from social activities and missing school — are hard for even the most mature teenager to handle.
Studies have shown that smoking increases risk of stroke sevenfold in women who have migraine with aura. If you are a female migraineur, you already have an increased risk of cardiovascular disease. Talk to your doctor about a smoking cessation program that will be compatible with your migraine treatment and slash your stroke risk.
Another challenge adolescent migraineurs face is restricted treatment options. Many migraine prophylactics and acute treatments are not well studied, and consequently not approved for use, in children and adolescents. Off-label use of migraine drugs thought to be safe for these age groups is an option. For the young woman who faces frequent migraines, dealing with a knowledgeable pediatric neurologist or headache specialist is crucial in developing an effective treatment program.
The frequency of migraine is at its highest between the ages of twenty-five and fifty-five for women, peaking in the early forties. That makes adulthood the most active stage of life for migraine disease. Fortunately, women are typically better equipped emotionally, physically, and financially to handle migraine in adulthood than they were during the sometimes-tumultuous period of adolescence.
Adulthood is also the time of life when building both a family and a career take center stage. Migraine can impact both. Pregnancy involves changes in treatment, covered later in this chapter, and migraine can cause disability in the workplace. The challenges of dealing with migraine on the job are covered in detail in Chapter 14.
For sexually active women, contraception choice is an important consideration for migraine treatment too. Nonpharmaceutical choices, such as an intrauterine device (IUD) or condoms, may be preferred. In women who have migraine with aura, the use of oral contraceptives could pose an increased risk of stroke or other cardiovascular events (beyond that associated with oral contraceptives in nonmigraineurs). The frequency of migraine without aura can also be impacted by oral contraceptive use. See the “Birth Control Pills” section later in this chapter for more information.
