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If headache jokes were fact, it would seem that migraines occur exclusively among long-married women when they are approached sexually by their husbands. Although this is not true, migraines are more frequently a female than a male stress symptom. The question is, why?

It would seem that there is a predisposition to react to stress in this way built in to the female physiology. Glands, various blood vessels, and scalp muscles may, under the influence of some female hormones, be particularly susceptible to stress triggers. Blood vessels that constrict spasmodically in reaction to stress may eventually dilate painfully. The walls of the vessels are now irritated and the blood pulsing through feels like pounding pain. This type of headache is a true migraine. Prolonged contraction of the muscles of the face, neck, and scalp produces what is generally called a tension headache. And, finally, secretions from various glands to raise energy levels under stress can also change fluid retention and electrolyte balances, causing yet a third type of headache.

Although fast relief from headache pain is offered in myriad television commercials, relief from the stresses that cause migraine headaches is even better.

Rosemary knew that her migraine attacks always followed situations in which she was enraged but felt that she couldn't express her anger. She claimed that she had had years of "nonassertiveness training," and feared that showing her anger would destroy her image as the patient wife and mother. She was, in fact, quite sure that her husband would stop loving her if he knew how often she felt irritable and annoyed at being taken for granted.

Imagine Rosemary's surprise when she began to request some appreciation from her family and got it! Her headaches gradually subsided, and she learned that her stress trigger had been an automatic fear of her own angry impulses. Other women have found that their dependency needs or sexual interests create similar conflicts and activate their headaches.

If the "unacceptable" impulse can't be identified or avoided, migraine may warrant a preventive medication (such as methysergide maleate) or ergotamine at its onset. Biofeedback techniques can be effective also, by helping women recognize autonomic nervous system changes before they reach headache proportions, and thus modulate fight, flight, or fright responses.