Estrogen shifts may be one cause of migraines, so keep a diary of
"triggers" to minimize suffering.

Few things affect quality of life as much as migraine headaches.
Although researchers still don't completely understand how migraines
develop, there are some clues. For starters, if one parent suffers
from migraines, a child has a 50% chance of developing them.

The stimuli that precipitate these headaches are referred to as
"triggers." They include alcohol; preservatives like nitrates,
nitrites and MSG; certain cheeses; sleep deprivation; skipped meals;
emotional stress; dental problems; and even some medications (such
as estrogen therapy).

Migraines occur more often in women than men, especially during the
reproductive years. This observation led doctors to connect
fluctuating estrogen levels and migraines. However, because there
are multiple triggers, the exact role of hormonal shifts in
migraines has been unclear.

To explore this relationship further, scientists from Canada and the
Netherlands studied a transsexual population. The study, conducted
in Amsterdam, included 50 sex change patients (male to female). All
50 were taking a regimen of medications to suppress testosterone
(the male hormone) and increase estrogen (the female hormone) in
their bodies.

This group provided a unique opportunity to explore the role
estrogen shifts may play in migraines. While most reported either
tension headaches or no headaches at all, 26% suffered migraine
attacks. That's about the same percentage of Dutch women who have
migraines; just 7.5% of Dutch men get them. This indicates that
hormone therapies likely are part of the picture. Why? These
treatments affect levels of nitric oxide, a substance in the body
that dilates blood vessels and increases blood flow.

To help the situation, keep a headache diary. It's simple: Have a
notepad and pencil handy, and, after a migraine attack, jot down
some information (see box, below).

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Charting migraine clues: What, when and why?

1. What were the symptoms? Be as descriptive as possible. Did other
symptoms (visual changes, a funny taste, yawning, etc.) precede the
headache? Did the headache occur on one side of the head, both
sides, in the back or behind the eyes? Was it throbbing or constant?
Dull or sharp? How long did it last? Did other conditions (nausea,
facial numbness, intolerance to light or sound, congestion)
accompany it?

2. When did it strike? Was it in the morning? (If so, did it wake
you from sleep?) After work? After exercise? After a meal? After a
prolonged fast? After sex? After an argument? Was it on the first
day of the workweek? On a weekend day after a late night? Did the
headache occur just before your menstrual cycle started? Also, note
what you had been doing before the migraine began.

3. Why do you think it happened? Is there a recurrent pattern with
food or alcohol? Log what you consumed before the headache. Record
anything that may be relevant: stresses, travel, weather changes.
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