Pregnancy planning a headache for many women

Almost 20% of women with migraine are avoiding pregnancy due to their condition, according to data from the American Registry for Migraine Research (ARMR).

Most (72.5%) believed their migraine would be worse during or just after pregnancy and 68.3% said the disability caused by migraine would make pregnancy very difficult.

Speaking at the ANZ Headache Society ASM, Dr Ryotaro Ishii, director of neurology at Kyoto Okamato Memorial Hospital, said 607 women responded to the question ‘Have migraines impacted your plans for pregnancy?’.

Women who chose to avoid pregnancy due to their migraine were typically younger and had no children (60%) than those who said migraine had no impact on their pregnancy plans.

The women avoiding pregnancy were more likely to have chronic migraine and depression, more headache days and higher MIDAS scores. More than a third of women said their migraine was always triggered by menstruation.

Dr Ishii said it was important to educate women of childbearing age that most women have migraine improvements during pregnancy.

Headache coexists with pelvic pain in young women

Young women with headache are more likely to experience pelvic pain given the overlap between chronic pain conditions.

Gynecologist and pain physician Associate Professor Susan Evans from the University of Adelaide, told the ANZ Headache Society that the gender pain disadvantage started in females at puberty. The most common situation was both abdominal pain and headache.

Associate Professor Evans said Australian data showed about 50% of women presenting with period-related pelvic pain were also troubled by headache.

She said management with diclofenac 100mg suppositories overnight would provide long-lasting relief from both headache and period pain. Co-medication with a triptan was also an option.

“For young women with background headaches it is worth considering that ‘oldie but a goodie’ amitriptyline because it does appear to be particularly successful in young women with visceral pain.”

She said even low doses of 5-10 mg can help reduce the background headache while also helping with pelvic pain, vulval pain, bloating and poor sleep.

New research findings of an inverse association between androgen levels and pain symptoms in women also pointed towards future management strategies.

$6 billion opportunity in prevention of migraine

A 10% reduction in the prevalence of migraines could save the economy more than $6.81 billion over 10 years, according to Victorian researchers.

The finding suggests that the costs of subsidising new treatments could return a greater pay-off to Australia through increased productivity, health economist Associate Professor Zanfina Ademi, from Monash University, told the ANZ Headache Society ASM.

She said estimates showed that migraine cost $8.4 billion or $6,665 per person in 2019.

The study found there were 1,274,319 Australians 20-64 yr old with migraine in 2019. About 72% of people with episodic migraine were women and 69% of people with chronic migraine.

It calculated that 317,819 quality adjusted life years (QALYs) would be lost over the next 10 years and, a new metric, 47,963 productivity adjusted life years (PALYs) lost.

“Over the 10 years, we estimated $68.13 billion costs with direct healthcare costs of $1.67 billion,” she said