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Migraines, Dizziness, and Cervicogenic Headaches in Women

By: Alexa Nicole Fiffick, DO, MBS • Posted on May 09, 2022

Migraines, Dizziness, and Cervicogenic Headaches in Women

Headaches are one of the most common neurologic disorders. Up to 75% of adults have had at least one headache in the last year. In most people, the headache pain is in the head or face. However, there are over 150 types of headaches, some of which are much more common than others. Two of the most common headache conditions are:

  1. Cervicogenic headache
  2. Migraine

Women and Headaches

Unfortunately for women, some headache disorders are more common in women than men and overall 70% of headache sufferers are women. In this column, I will discuss common headache types so you can better understand your symptoms and get the proper treatment.

Migraine

The pathophysiology, or cause, of migraine headaches are not fully understood yet by experts.

  • A recurrent headache disorder that involve chronic attacks that last from 4-72 hours.
  • Usually are moderate-to-severe, unilateral, or one-sided, located at the front and/or side of the head and often near an eye.
  • Characterized by a pulsating-type pain that is worsened with physical activity and is often associated with sound sensitivity, light sensitivity and nausea.
  • Can be associated with vision changes and dizziness.

Prodrome

A prodrome is a symptom or group of symptoms that occur within hours up to 2 days prior to the onset of a migraine attack.

Prodrome symptoms
  • Fatigue
  • Neck stiffness
  • Light sensitivity
  • Sound sensitivity
  • Nausea
  • Yawning
  • Pallor
  • Blurred vision
  • Difficulty concentrating

Postdrome

A postdrome is symptom or group of symptoms that occur following resolution of a migraine attack. These can last up to 48 hours following the attack.

Postdrome symptoms
  • Fatigue
  • Difficulty concentrating
  • Neck pain

More research needs to be done in this area because we do not have sufficient data regarding postdromes and migraine at this time.

Aura

Auras are the neurologic symptoms that occur with migraine that are not part of its core features. Thus, it can occur before, during or after the actual attack itself.

Aura symptoms
  • Change in vision
  • Sensation (touch, taste, smell)
  • Speech/language
  • Motor function
  • Brainstem functioning (gait)

Visual auras are the most common type, occurring in more than 90% of patients that have migraine with aura.

Menstrual cycle relationship

  • Less than 10% of women have migraine attacks that are associated with menses
  • Most menstrual migraines are not associated with aura
  • These attacks are often longer and associated with higher rates of nausea than non-menstrual migraines

Menstrual migraines often worsen in severity and/or frequency when going through perimenopause or the menopause transition. This is due to significant fluctuations in female hormone levels that occur during this time. Luckily, they frequently resolve or lessen in severity/frequency with cessation of menses that comes after the menopause transition.

Menstrual migraine treatment

These can often be controlled well with birth control or other appropriate hormone therapy as it stabilizes those hormone fluctuations - even if you suffer from aura. In the case of aura, your women’s health physician can choose a low dose birth control that is safe for you with a dosing regimen that can improve your symptoms.

Cervicogenic headaches

  • Cervicogenic headaches are a type of headache caused by disorders in the cervical spine or neck, and it’s adjoining anatomical structures.
  • This type of headache is typically unilateral, or one-sided, and is most often caused by the three uppermost nerves of the neck.
  • The one-sidedness, along with other factors, often cause difficulty in differentiating this type of headache from migraine.
  • Up to 50% of cervicogenic headaches are misdiagnosed, leading to incorrect treatment choices.

Cervicogenic headache treatment

  • There is evidence that Botox injections and medication therapy are not beneficial
  • Physical therapy can be very helpful

If this sounds like it describes the headaches you’ve been experiencing, ask your primary care physician to refer you to a headache specialist.

The headache specialist will be able to assist with determining if it is a true cervicogenic headache or another problem causing the pain. This may be the type of headache you’re experiencing if the pain is made worse by neck movement, prolonged head positioning or by external pressure over the head/neck on the affected side.

Women and Dizziness

You might think that the word “dizziness” has a singular definition, however, being dizzy can mean very different things from person to person. To some, this may mean they feel like the room is spinning while to others, this may be a sensation of lightheadedness or even like they may faint.

Different types of dizziness have different causes. For example, benign paroxysmal positional vertigo, a specific type of vertigo, is caused by loose calcium crystals in the ear. This can be diagnosed clinically by your doctor and improved with in-office, at home, or physical therapy-directed exercises.

Similarly, many patients experience dizziness with their migraines or cervicogenic headaches. However, dizziness can also have some more sinister causes such as:

  • Cardiac arrhythmias
  • Low blood cell count (anemia) due to heavy periods or other bleeding
  • Low blood pressure
  • Neurologic conditions

Because of this, it is important to speak to your doctor to ensure the cause of the dizziness you’re experiencing is not due to one of the more concerning causes.

If you have new-onset dizziness, new or worsening headaches, headaches that have changed in type or frequency, or new symptoms associated with your headaches (nausea, vomiting, dizziness, vision changes) talk to your doctor right away.

Be Strong, Be Healthy, Be in Charge!

-Alexa N. Fiffick, DO, MBS

About Alexa Nicole Fiffick, DO, MBS

Dr. Alexa Nicole Fiffick is a Board Certified Family Medicine physician. She is a first year clinical Specialized Women’s Health Fellow at the Cleveland Clinic Center for Specialized Women’s Health.

Dr. Fiffick was born and raised in Greater Cleveland, Ohio. She graduated from Case Western Reserve University in 2012 with a Bachelor’s in Sociology with minors in Dance and Chemistry. She achieved a Master’s in Biomedical Science at The Commonwealth Medical College in 2013. She spent a year working in research at the Cleveland Clinic. Then, she went to medical school at Alabama College of Osteopathic Medicine, graduating in 2018.

Dr. Fiffick graduated from Doctors Hospital Family Medicine program for residency, with a certified focus on Women’s Health. She spent time working with underserved communities via Mobile Medicine in residency. Through this she fell in love with caring for underserved women and women in mid through later life.



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