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Most Common Women’s Sports Injuries

A woman’s sports injuries are basically the same as a man’s.

But there are some peculiarities due to differences in anatomy and issues related to the menstrual cycle.

Here’s a look at some of the most common overuse sports injuries suffered by women, including stress fracture, runner’s knee, jumper’s knee, tennis elbow, and frozen shoulder, and how to treat them.

Stress Fracture

Women tend to have a higher incidence of stress fractures then men.

Stress fractures occur from repetitive forces.

They are more common in women who do not menstruate compared to those who do.

A woman with osteoporosis or osteopenia (low bone density) will also be at greater risk of stress fracture because of decreased bone density.

Weight-bearing exercises, such as walking, dancing and jogging, are particularly valuable in reducing bone loss in middle-aged and postmenopausal women, and may help prevent osteoporosis.

Runner’s Knee

Runner’s knee, or patellofemoral pain syndrome, is characterized by a stable, but painful knee.

This is much more common among women because a woman’s pelvis is wider, making the angle between the thigh and the calf sharper, which is known as an increased Q-angle.

This results in greater force toward the front and inner part of the knee.

The tendency is for the kneecap to pull out of line and rub on the side of its groove, causing knee pain.

Conservative treatment includes physical therapy, core strengthening, stretching of quadriceps and hip external rotator muscles, bracing, and biomechanical analysis and correction.

Jumper’s Knee

Jumper’s knee, or patellar tendinitis, is characterized by pain in the front of the knee.

Pain increases with running and jumping, and the pain symptoms may intensify during the night and upon waking in the morning.

The pain comes from inflammation of the tendons that hook into the upper and lower ends of the kneecap.

The more you train and the higher the intensity of your training, the more you feel the pain.

The first treatment is to rest long enough to get over the acute pain, and to take anti-inflammatory agents to reduce the pain, if necessary.

If pain continues or increases, cortisone injections can help manage the pain and swelling, or surgical treatment may be required.

Tennis Elbow

Tennis elbow, or lateral epicondylitis, is an overuse injury to the tendons at the lateral humeral epicondyle, the bands of tissue that connect the arm muscles to the outside aspect of your elbow area.

It is usually associated with lack of forearm strength.

Lateral epicondylitis most often occurs in women between ages 30 and 50.

The tennis backhand stroke, which involves repeated wrist extension against resistance, increases the risk of symptoms at the outside of the elbow.

Conservative treatment should include physical therapy, bracing, and biomechanical analysis and correction of repetitive activity.

In severe cases, surgical treatment may be required.

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is seen most often in women between ages 40 and 70.

It is often seen in combination with other shoulder conditions (such as rotator cuff problems) or diabetes mellitus.

The hallmark symptom of frozen shoulder is decreased range of motion and severe shoulder pain.

It often disappears on its own.

Conservative treatment usually involves taking anti-inflammatories to reduce pain and inflammation.

A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Relief of symptoms is gradual and recovery takes from 12 to 18 months, on average.

Surgical options for adhesive capsulitis include joint manipulation under anesthesia and capsular release.

Take a Break

Overuse injuries usually require you to suspend activity.

A biomechanical analysis and correction are components to successful recovery and should be performed by sports medicine professionals.

Prevention is also a key component by maintaining a fit and healthy lifestyle.

Core training and strength training of both the lower and upper body can maintain muscular strength and endurance, and help to prevent chronic overuse injuries.

Reduce Your Heart Attack Risk: Eat a Low-Risk Diet, Make Healthy Lifestyle Choices

It’s not a new formula, but a new, large study shows that almost 4 of 5 heart attacks may be preventable in men who adhere to 5 healthy habits.

Combining 5 low-risk behaviors – eating a healthy diet, consuming moderate amounts of alcohol, not smoking, being physically active, and maintaining a healthy weight – may prevent almost 80% of myocardial infarctions (MI) among men.

“Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of MI,” state the authors, led by Agnetta Akesson, PhD, Senior Lecturer in Epidemiology at the Karolinska Institute in Stockholm, Sweden.

The researchers set out to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men.

They conducted a population-based, prospective cohort study of more than 20,000 Swedish men, aged 45 to 79 years, who completed a detailed questionnaire on diet and lifestyle at baseline in 1997.

The men who had no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009.


Low-risk behaviors included 5 factors: a healthy diet, moderate alcohol consumption, no smoking, being physically active (walking or bicycling 40 or more minutes a day, and exercising 1 or more hours a week), and having no abdominal body fat.

During 11 years of follow-up, the researchers found 1,361 incident cases of MI.

The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 compared with men having 0 of 5 low-risk factors.

Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14.

“This combination of healthy behaviors, present in 1% of the men, could prevent 79% of the MI events on the basis of the study population,” the authors state.

The incidence of MI decreases with the number of positive behaviors in both healthy men and in those with hypertension and high cholesterol, they note.

In conclusion, the authors state “almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior regimen.

Further studies are needed to develop population-based strategies to promote healthy behaviors that can be introduced early in life and maintained throughout the life span.”

In an editorial, Dariush Mozaffarian, MD, DrPH, Adjunct Associate Professor of Epidemiology at the Harvard School of Public Health, stated that this study adds to previous reports “…by evaluating a large, contemporaneous study population enrolled from the general community.”

Dr. Mozaffarian noted that “substantially lower MI risk was seen with adherence to very basic lifestyle behaviors.”


For example, eating a diet richer in minimally processed, healthful foods was associated with a nearly 20% lower risk.

“These healthful diets were neither extreme nor exceptional, but reasonable and consistent with dietary guidelines (about 5 daily servings of fruits and vegetables, 4 daily servings of whole grains and 2 weekly servings of fish).”

He emphasized that the benefits were related to higher intakes of more healthful foods, not lower intakes of unhealthy foods.

The researchers reported their results in the September 2014 issue of The Journal of American College of Cardiology.

Modest Alcohol Consumption Lowers Semen Quality

Drinking modest amounts of alcohol may affect the sperm quality of young men, according to a new study.

“Young men should try to avoid habitual alcohol intake of more than 5 units weekly and especially more than 25 units weekly, which may be beneficial not only for their general health but their semen quality as well,” said Tina Kold Jensen, Professor of Research at the Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark.

One unit of alcohol was defined as the equivalent to 1 beer, 1 glass of wine, or 1 shot of alcohol.

“We also found that increasing alcohol consumption the week preceding the visit was associated with changes in reproductive hormones, especially a significant increase in serum free testosterone and reduction in sex hormone binding globulin,” Dr. Jensen said.


This appears to be the first study among healthy young men with detailed information on alcohol intake.

Dr. Jensen said, “Previous studies have not found adverse effects of low alcohol intake (more than 5 units per week), however, they only assessed average intake.

We assessed daily intake the week preceding the semen delivery.”

She added: “We think we found a strong association because we asked the men about intake last week and then extrapolated to a normal week.

We know that normal sperm take 3 months to mature.

Normal consumption is a better marker than just last week’s consumption.”


The cross-sectional, population-based study asked 1221 men to fill out a questionnaire on whether the previous week was a “normal” week of alcohol consumption and then studied the 553 who stated that it was.

These men, age 18 to 28 years, all had undergone a medical examination between 2008 and 2012 to assess their fitness for military service, which is compulsory in Denmark.

Sperm concentration, total sperm count, and percentage of spermatozoa with normal morphology were negatively associated with increasing habitual alcohol intake.

This association was observed in men reporting at least 5 units in a typical week but was most pronounced for men with a typical intake of more than 25 units per week.

Men who had a typical weekly intake of more than 40 units had a 33% reduction in sperm concentration compared with men who had an intake of 1 to 5 units per week.

Binge drinking was not independently associated with semen quality.

“We do not know how much of a direct effect on semen quality was due to the adverse effect of alcohol on spermatogenesis, but we adjusted for other lifestyle factors, such as smoking, diet, and exercise,” said Dr. Jensen.

“But it may be a certain lifestyle associated with alcohol intake that is harmful to semen quality.”

The researchers think that even moderate alcohol consumption could be a contributing factor in the low sperm counts reported among young men.

Whether semen quality is restored if alcohol intake is reduced remains to be seen, they stated.

The researchers reported their results in the October 2, 2014 issue of the British Medical Journal Open.

Improve Your Golf Game by Strengthening Your Core

A golfer’s score ultimately is determined by athletic talent, amount of time devoted to practicing and playing, and level of physical fitness.

If you’re like most golfers, you probably overlook the fitness component and try to get by on natural talent and regular play.female golfer_pic_4

However, the more rounds you play without working on your conditioning, the greater are your chances of injury.

Mike Markee, PT, ATC, instructor of physical therapy and athletic training at Saint Louis University, has spent time on the senior PGA tour and developed exercise and fitness programs for golfers.

“It is possible to avoid injury and improve performance, especially through muscle strength and proper form,” says Markee.

“The great thing is that the same things that help you avoid injury also will improve your game.”

He recommends 3 things to keep your body in shape for golf:


There can be a lot of down time in golf, and so it takes deliberate focus to keep moving.

Stretch before, during, and after each round.

If you’re able to walk and the course allows, skip the cart and earn a few miles under your belt by the end of the game.


Golfers use the muscles closest to the spine, including hip and shoulder muscles.

This is where the power comes from in your golf swing, and, likewise, a weakness in your core can lead to an unbalanced swing, with some muscles compensating for others.

“It used to be thought that flexibility was most important thing in golf.

Golfers worried that too much muscle would cause them to lose flexibility,” says Markee.

“But, with rise of Tiger Woods and now Rory Mcllroy, we’ve seen that you can develop more power by training the right muscles.

Now we know that strength training and flexibility aren’t polar opposites, and, in fact, core strength training can actually improve your performance.

“From a health care perspective, a muscle weakness in the core or hip is something we can remedy through physical therapy or athletic training.”


Golf’s main injury risk comes from the repeated motions of the swing.

Working with a pro to learn to swing properly can help you reduce forces on the spine due to twisting and rotating and ensure that you aren’t developing bad habits that can take their toll on your back, shoulder, and elbow.

Amateur golfers generate greater sheer force on their spine compared to professionals, Markee notes.

“Usually back pain comes from the twisting that puts stress on the spine,” he says.

“Back injuries from golf are very common.

If golfers lose their spine angle on the back swing, it can increase forces on the spine, causing back pain. The torsion can be damaging if done over and over.”

Learn from a pro about proper swing to develop good body mechanics and avoid pain down the line, and, if you do have pain, consult a physician sooner rather than later to avoid exacerbating the problem.

Predicting Sports Injuries Before They Happen

Imagine if you could tell when you were about to tear a rotator cuff well before it happened.

That’s what researchers at Washington University in St. Louis hope to be able to do for athletes, and possibly prevent sports injuries.

They have developed algorithms to identify weak spots in tendons, muscles, and bones prone to tearing or breaking.

The technology may one day help pinpoint minor strains and tiny injuries in the body’s tissues long before bigger problems occur.

“Tendons are constantly stretching as muscles pull on them, and bones also bend or compress as we carry out everyday activities,” said senior investigator Stavros Thomopoulos, PhD, Professor of Orthopaedic Surgery at Washington University.

Small cracks or tears can result from these loads and lead to major injuries.

Understanding how these tears and cracks develop over time therefore is important for diagnosing and tracking injuries.”

Visualizing Weak Spots

The researchers have developed a way to visualize and even predict spots where tissues are weakened.

To accomplish this, they stretched tissues and tracked what happened as their shapes changed or became distorted.

The new, more powerful algorithm allowed them to find the places where the tears were beginning to form and to track them as they extended.

They believe the algorithms can be used to measure the pressures and forces that act on the body and cause tissues such as muscles and tendons to crack or tear.

Predicting Rotator Cuff Tears

“If you have a small tear in the rotator cuff, when the tendon stretches, that crack may get bigger,” said Thomopoulos.

Eventually, they hope to predict problems in tendons and muscles as in the rotator cuff.

“If you have a perfectly normal rotator cuff, you can image it in a way to see how the tendon performs moving up and down.

If the tendon is normal, then the strains on it will be normal.

If you have a weak spot in the rotator cuff, the strains in that local area that may be starting to degenerate would probably be higher,” he said.

Those higher strains could predict problems.

This could also help them learn why some surgeries to repair rotator cuff injuries ultimately fail.

Their goal is to increase the odds that the tissue in the shoulder will heal following surgery, and they believe the new algorithms could help them get closer to that goal.

They also want to use the algorithms to prevent additional injuries following surgery to repair knees, shoulders, and other tissues.

So far, they have only used the algorithms in the laboratory on materials, such as plastic wrap, and in animal models.

How soon the new algorithms could be used in patients depends on getting better images of the body’s tissues, they said.

The researchers reported their results online on August 27, 2014 in the Journal of the Royal Society Interface.

The Benefits of Tai Chi: Strong Body, Healthy Heart

If you have heart disease, you may want to find a physical activity that you can easily maintain.

The slow-paced “meditation in motion” of Tai Chi may be just what the doctor ordered.TaiChi older

Based on the existing evidence, Tai Chi is a promising addition to regular heart care.

Cardiac rehabilitation programs are, unfortunately, underused.

“Tai Chi may be a good option for those unable or unwilling to engage in other forms of physical activity, or as a bridge to more rigorous exercise programs in frail patients,” says Peter Wayne, Ph.D., assistant professor of medicine at Harvard Medical School and the director of research for the Osher Center for Integrative Medicine, jointly based at Harvard Medical School and Brigham and Women’s Hospital in Boston.

“If your doctor says you have borderline high blood pressure and you are not certain you want to begin drug therapy, a non-pharmacological approach such as Tai Chi may be a way to keep your blood pressure in check.

If you have established high blood pressure and find it difficult to engage in a regular exercise regimen, again, think about using Tai Chi to aid the treatment program your doctor has designed for you.”

Regular physical activity, including Tai Chi, has beneficial effects on many risk factors for heart disease, such as high blood pressure, high cholesterol levels and pre-diabetes, says Ruth E. Taylor-Piliae, Ph.D., R.N., associate professor and Robert Wood Johnson Foundation nurse faculty scholar alumna at the University of Arizona’s College of Nursing in Phoenix, where she conducts Tai Chi research.

“Regular physical activity promotes weight reduction, which can help reduce high blood pressure.

Exercise can lower total LDL, or “bad”, cholesterol levels, as well as raise HDL, or “good”, cholesterol levels,” she says.

“Among those with pre-diabetes, regular exercise can aid the body’s ability to use insulin to control blood glucose levels.”

Importantly, all studies to date suggest that Tai Chi may be safe for heart patients.

It may offer you additional options, whether in addition to a formal cardiac rehab program, as a part of maintenance therapy or as an exercise alternative.

Strong Social Ties Protect Men From Suicide

Being socially connected to others appears to protect men against suicide, according to a new study.

Social integration acts as a safety net to lower the risk of suicide among men.

We speculate that men who are more socially well integrated may have greater access to emotional support and have more opportunities for social engagement and reinforcement of meaningful social roles,” said Alexander Tsai, MD, PhD, Assistant Professor of Psychiatry at Harvard Medical School in Boston.

Suicide is one of the 10 leading causes of death among men in the United States, and suicides among middle-aged men are increasing.

Current trends in research and prevention efforts usually emphasize the psychiatric, psychological, or biological aspects of what drives suicidal thinking and suicidal behavior.

However, research has shown that a substantial proportion of suicides occur in the absence of a formally diagnosed mental disorder, suggesting that a deeper understanding of factors driving suicide is needed, he said.


Dr. Tsai and colleagues analyzed data from the Health Professionals Follow-up Study, an ongoing prospective cohort study of nearly 35,000 men aged 40 to 75 years, to examine the relationship between social integration and suicide mortality over 24 years of follow-up.

They measured social integration with a 7-item index that included marital status, social network size, frequency of contact, religious participation, and participation in other social groups.

Over more than 700,000 person-years of follow-up, there were nearly 150 suicides.

The incidence of suicide decreased with increasing social integration.


Three components — marital status, social network size, and religious service attendance — showed the strongest protective associations.

Social integration also was inversely associated with all-cause and cardiovascular-related mortality, but accounting for competing causes of death did not substantively alter the findings.

“Men who were socially well-integrated had a more than 2-fold reduced risk for suicide over 24 years of follow-up,” Dr. Tsai said.

The study lacked information on participants’ mental well-being.

Some suicides also could have been misclassified as accidental deaths, he noted.

Dr. Tsai added: “The seminal studies about social integration and suicide are based on macro-level data, for example, examining the level of social integration across counties or states and the correlations with suicide rates in those jurisdictions, but these are subject to the well-known ‘ecological fallacy’—just because there is an association at the county or state level does not necessarily imply that an individual with poor social integration is also more likely to commit suicide.”

A fuller understanding of the role of social interaction is important in understanding suicide.

“The bottom line is that we should be approaching suicide as a public health issue relevant to a broad range of medical practitioners and public health specialists, not just a narrow mental health issue relevant only to psychiatrists like myself,” Dr. Tsai said.

“It is important for primary care physicians to recognize that their most socially isolated patients are at elevated risk of committing suicide.”

The researchers published their results in the July 14, 2014, issue of Annals of Internal Medicine.

No Added Heart Attack Risk With Testosterone Therapy in Older Men

Testosterone therapy does not increase the risk of heart attack, or myocardial infarction (MI), among older men, according to a comprehensive new study.

“We believe this is a methodologically rigorous study and should be thoughtfully weighed, critiqued, and discussed alongside the other studies of testosterone therapy and cardiovascular outcomes,” said lead author Jacques Baillargeon, PhD, Director, Epidemiology Division and Associate Professor of Preventive Medicine & Community Health at the University of Texas Medical Branch in Galveston.

“Although recent observational studies have reported an increased risk of cardiovascular disease associated with testosterone use, there is a large body of evidence that is consistent with our finding of no increased risk of MI associated with testosterone use,” Dr. Baillargeon said.

He noted that there are cardiovascular risks associated with untreated hypogonadism (a condition in which the body doesn’t produce enough testosterone) and those should be factored into the risk-benefit assessment about testosterone therapy.


Testosterone prescriptions for older men in the United States have increased more than 3-fold over the past decade.

This trend has been driven by increases in direct-to-consumer marketing; rapid expansion of clinics specializing in the treatment of low testosterone; the development of new drugs and improved delivery mechanisms, particularly dermal gels; and greater diagnostic awareness of hypogonadism, stated Dr. Baillargeon.

The retrospective study used information from 25,000 Medicare beneficiaries aged 66 years and older.

It compared more than 6,300 men treated with testosterone for 8 years with more than 19,000 who were not treated with testosterone.

“We found that use of intramuscular testosterone therapy was not associated with an increased risk of MI,” Dr. Baillargeon said.

In fact, testosterone was associated with a possible protective effect — reduced risk of MI in patients with the highest prognostic risk index.

There were no differences in risk in patients in the lower prognostic risk groups.


There are a number of physiologic pathways whereby testosterone therapy may affect the risk of adverse cardiovascular events.

“Some have reported that testosterone therapy may improve cardiovascular health by way of decreasing fat mass, insulin sensitivity, and lipid profile,” said Dr. Baillargeon.

“Also, testosterone may possess anti-inflammatory and anticoagulant properties.”

He continued, “It is possible that our findings of a protective effect among men in the highest MI prognostic group reflect a process whereby testosterone reduces peripheral vascular resistance, thereby reducing stress on the heart among those who have some degree of coronary artery disease.

It is important to note that there are also postulated mechanisms through which testosterone may increase the risk of cardiovascular disease.

Given the broad range of proposed biologic pathways, it is important to conduct further research on this topic.”


Several recent studies have raised concerns about cardiovascular risks associated with testosterone therapy, in particular for older men.

On June 19, the FDA expanded labeling on testosterone products to include a general warning about the risk of blood clots in veins.

The FDA and European Medicines Agency also are further examining the safety of these products.

The researchers reported their results in the July 2, 2014 issue of the Annals of Pharmacotherapy.

Migraines Worsen During Menopausal Transition

The frequency of migraine attacks is higher in women during perimenopause and postmenopause than in premenopause, according to the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition.

“Fluctuating estrogen levels play an important role in initiating migraine in women,” said study co-author Richard B. Lipton, MD, Co-Director of the Montefiore Headache Center and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine.

“Migraine onset increases with the beginning of menstruation and is more common around the time of bleeding during the menstrual cycle,” he said.

“The trigger factor is thought to be declining estrogen levels.

As menopause approaches, estrogen levels fluctuate and likely trigger migraine.”

Dr. Lipton noted that estrogen and other sex hormones act on the brain and alter the excitability or sensitivity of the nervous system.


The research was conducted as part of the American Migraine Prevalence and Prevention (AMPP) Study, a longitudinal mailed questionnaire survey of 120,000 households selected to be representative of the US population.

Data from the 2006 AMPP Study survey were used.

Women with migraine aged 35 to 65 years were eligible for the analyses.

Women with migraine were classified based on headache frequency.

A high-frequency group experienced 10 or more headache days per month, and a low- or moderate-frequency group experienced episodic migraines on fewer than 10 days per month.

The women also were classified based on menopausal status.

The premenopausal stage was characterized by regular menstrual cycles.

The perimenopausal stage included women with cycle lengths that varied by at least 7 days or periods of no periods lasting 2 to 11 months.

The postmenopausal stage was defined by no periods persisting for at least 12 months.

The analysis included more than 3600 women, mean age 45 years, with about one-third of them in each of the 3 groups.


Frequent headache (10 or more days per month) was 50% to 60% more common among perimenopausal women (12.2%) and menopausal women (12%) compared with premenopausal women (8%).

Consistent with the clinical impression that migraine worsens during the menopausal transition, these data show that the risk of high-frequency headache is greater during perimenopause and postmenopause as compared with premenopause, Dr. Lipton said.

The researchers concluded that longitudinal studies should examine within-person trajectories of headache frequency and the role of hormonal mechanisms among migraineurs during the menopausal transition.

“In the present report, we compared groups of women who were premenopausal and perimenopausal and postmenopausal in the year of the study,” Dr. Lipton said.

In a longitudinal study, we would follow individual women as they transitioned from premenopausal to perimenopausal to postmenopausal and examine the hormonal changes that underlie changes in headache frequency.”

He added: “Clinicians should know that headaches may get worse as women begin the menopausal transition.

When patients experience migraine worsening, clinicians can explain that hormonal changes may be driving the changes.

Controlling headache is one factor that may contribute to the complex decisions about when to recommend hormone replacement therapy.”

The researchers presented their results on June 20, 2014 at the 56th Annual Scientific Meeting of the American Headache Society in Los Angeles.

Chronic Migraine Burdens Whole Family

Chronic migraine has significant effects on family relationships and activities, according to the results of a new study.

“The effects of chronic migraine can be devastating and far-reaching.

The results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) study highlight the significant impact of chronic migraine not only on the person with migraine but on the entire family,” said Dawn Buse, PhD, Director of Behavioral Medicine, Montefiore Headache Center, and Associate Professor, Clinical Neurology, at Albert Einstein College of Medicine.

Dr. Buse led a study to assess the nature and extent of chronic migraine on family activities and relationships.

“Among 994 women and men who met criteria for chronic migraine, respondents reported missing both routine and special family events on a regular basis and feeling guilty and sad about how this affected their relationships with their spouses and children,” she said.


Almost three-fourths of respondents said they would be better spouses if they did not have chronic migraine.

Almost two-thirds felt guilty about being easily angered or annoyed by their partners because of headache, and at times two-thirds avoided sexual intimacy with their partners because of headache.

The majority of respondents also endorsed that they would be better parents if they did not have chronic migraine.

“About two-thirds of respondents reported that they became easily annoyed with their children due to headache,” Dr. Buse said.

“In addition, slightly more than half of respondents reported that they had reduced participation or enjoyment on a family vacation due to headache in the past year, and 20% cancelled or missed a family vacation altogether.”


The data suggest that women with chronic migraine appear less impaired and burdened by the condition than men.

“However, it is not clear whether there is truly a qualitative difference between the sexes in the nature and severity of attacks or differences in responses and resiliency to migraine attacks,” Dr. Buse said.

“We could hypothesize that males may have a smaller number of family and parenting responsibilities and commitments than females, making their percentage of missed events higher than the percentage for females.

It is also possible that mothers and wives feel that they cannot miss a family event or drop a responsibility.

In this case they may continue their activities despite debilitating pain and associated symptoms.”

The study highlights the point that chronic migraine is a debilitating disease that can affect all aspects of life, including roles, responsibilities, and relationships within the family.

“We hope that these data will help health care professionals further realize the scope of the burden of this condition and be diligent in providing accurate diagnoses and thorough treatment plans,” Dr. Buse said.

Those treatment plans should include both appropriate pharmacologic and nonpharmacologic (cognitive behavioral therapy, biofeedback, and relaxation training) interventions, she noted.

In addition, Dr. Buse advises health care professionals to encourage and facilitate patients in seeking help from mental health care professionals when these feelings become overwhelming.

Dr. Buse presented the results of the study on June 27, 2014 at the 56th Annual Scientific Meeting of the American Headache Society in Los Angeles.