MENSTRUAL MIGRAINES Tennis star fighting back

Getting back a good quality of life is the goal.
MIAMI -- Call it the $100,000 headache.
That would be the conservative estimate of how much Top 5-ranked tennis star Serena Williams says she lost last year when the pain from a menstrual migraine cost her a match in an Austrian tournament.
She says she doesn't remember who her opponent was, "or maybe I do; it doesn't matter."
Point is, the throbbing pain and dizziness led to her losing in the first round, something that hasn't happened since the phenom was 14.
Williams, 23, younger sister of tennis star Venus Williams, was at Miami Beach's Raleigh Hotel recently to discuss her work with Endo Pharmaceuticals. Williams and the Pennsylvania company teamed to promote Rally for Menstrual Migraine, an effort to raise awareness among women who suffer from menstrual migraines.
About 13 million American women are affected, according to Suzanne Simons, executive director of the National Headache Foundation.
It adds up
This results in a loss of productivity and missed workdays costing employers $5.6 billion to $17.2 billion annually, adds Dr. Jan Brandes of the Department of Neurology at Vanderbilt University School of Medicine in Nashville.
But for Williams, it was personal.
"I never lost the first round of a tournament, well, once. My first tournament at 14 so I don't count that," says Williams, gold chains dangling just so from her neck. "So here I am, playing pretty good, at the top of my game, and I go to this tournament in Austria and I'm having a migraine. Bad feeling. I'm dizzy. At points, I can't breathe. I'm so tired of having to deal with this migraine. I did lose the match, unfortunately."
The cost?
She pauses, smiles, thinks a bit. "I would say, definitely, upwards of a couple hundred thousand.
"That's when I decided I had enough."
It's an issue that hasn't been discussed often enough, says Simons. "Women don't have to suffer. They can get their quality of life back."
The variations
There are two types of menstrual migraines -- menstrually related migraine and pure menstrual migraine.
A menstrually related migraine is an extremely painful headache that happens during a woman's period but can occur at other times of the month, too. A pure menstrual migraine is similar but occurs solely during the period.
Williams suffered the latter.
"I always was told when women go through that time of the month it's assumed they'll have headaches and different cravings. I grew to accept it."
That's the problem, Brandes says.
"Women accept this headache as part of the menstrual cycle they have to endure but there are treatments. The disorder is increasingly being recognized. Women have to be diagnosed and realize that they don't have to accept that this is part of their cycle."
The exact causes are uncertain but studies indicate it may have something to do with the drop in estrogen hormone levels that normally occurs before a period starts.
Up to 60 percent of migraines in women are associated with menstruation. Symptoms include throbbing or pounding pain in the head, nausea and vomiting, sensitivity to light or sound, loss of appetite and fatigue.
Some success
Frovatriptan, or Frova, a member of the class of drugs called triptans, is one treatment for menstrual migraines -- successfully in the case of Williams, she says -- and was approved for use by the FDA in November 2001. Analgesics and alternative remedies are other options.
The FDA-approved dosing for Frova is one 2.5 milligram tablet up to three times a day when a migraine begins. Williams, whose plate includes a reality show premiering on the ABC Family network in July with her big sis and promoting their motivational book Serving From the Hip: 10 Rules for Living, Loving, and Winning (Houghton Mifflin, $14), takes one pill a day. She reports no side effects, which can include dizziness, fatigue, dry mouth and chest pain.
"I'm excited to have it in my life," Williams says, "I don't have to worry about dealing with migraines and opponents. Now, I just have to deal with opponents."
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