If you are one of the 28 million Americans suffering from migraine pain, you might feel as though you're doomed to a lifetime of throbbing headaches. With the female to male ratio at 3:1, there is a clear gender bias when it comes to migraines, a disparity that mainly has to do with hormones.

There seems to be a significant connection between estrogen levels and the onset and presence of migraines. Fluctuations in estrogen seem to affect the central nervous system and the rise and fall of estrogen may trigger a migraine. Although the first attack is quite often during the teen years, with the onset of menstruation, migraine frequency and intensity seem to peak when a woman is in her 40s.

How to cope with menstrual migraines
Migraines that are linked to your menstrual cycle usually occur without an aura and their timeframe is usually during the two days before or two days after menstruation begins. Most women who suffer from migraines will have them throughout the month, but a small group of women will exclusively have these menstrual migraines.

You can reduce menstrual migraines by creating a therapy plan that targets migraine prevention, which provides rescue medications that immediately intervene during early onset of an attack and identifying common triggers like stress. Steering clear of sodium and MSG can also help to prevent PMS bloat and migraine pain.

Migraines during pregnancy
Some women experience a reduction of migraine attacks during pregnancy due to hormonal shifts. Others may notice an upswing in the number of attacks. It's important to work with your obstetrician and headache specialist to determine the medications that are safe to take for prevention, rescue and the pain associated with migraines during pregnancy. There are also lifestyle changes you can make to optimize the joy of pregnancy while minimizing the likelihood of a migraine attack.

Menopause and your migraines
Two thirds of women's migraines improve within a couple of years after menopause while 10 percent experience worse headaches. Approximately 25 percent notice no change at all. Hormone replacement therapy is now being selectively offered to women for severe, debilitating hot flashes but because of migraine sufferers' variable reaction to hormones, there's no way of knowing who will respond positively or poorly to menopausal hormonal supplementation.

Can birth control help relieve migraine pain?
Some women who use an oral contraceptive do find relief, though most women don't notice a change. Some oral contraceptive users will find an increase in migraine attacks during the placebo week of the 30-day pack. Women who have migraines with aura seem to increase their risk of having a stroke if they take an oral contraceptive.

It will be obvious when you start an oral contraceptive whether or not it helps, makes things worse or has little impact. It's important to talk to your doctor beforehand and to start out with the lowest effective dose of estrogen. Progesterone does not seem to factor into the migraine discussion.

Remember the goal of treatment is to reduce the number of attacks and the severity of symptoms. You'll then want to determine the appropriate medications that will immediately avert an attack. There is currently no cure for migraines but researchers are continuing to explore the mechanisms that cause migraines, new therapies and prevention strategies.