Laura Popelar has suffered headaches for as long as she can remember.
But it was the stress of nursing school that first brought on debilitating migraines that made it difficult to function.
"The intensity kicked up," said Popelar, now 42 and a nurse practitioner in Columbus. "I was having nausea and sometimes vomiting."
Although 13 percent of Americans experience migraines, women suffer at a higher rate. In fact, 18 percent of women complain of migraines, compared with 6 percent of men.
"It's about 3-to-1," said Dr. MaryAnn Mays, a neurologist and migraine specialist at the Cleveland Clinic.
Why women disproportionately experience migraines is unclear.
In Popelar's case, the headaches often were triggered by skipping meals, getting too little sleep and, "in general, not taking very good care of myself," she said.
Mays said hormonal changes, such as those that occur during menstrual cycles, pregnancy and menopause, can bring on migraines.
Most migraines, she said, occur among women 20 to 50 years old.
"Men and women are probably equally likely to have migraines," said Dr. Geoffrey Eubank, a neurologist with Neurological Associates in Columbus. "It's just that hormonal changes in women tend to bring them out more frequently."
Migraine sufferers often are extremely sensitive to light and sound, often experience nausea, and sometimes experience the pain as localized on one side of the head.
"There might also be some difference in pain," Mays said.
She said clinical trials using mice suggest that women might have a lower tolerance for pain. Still, both men and women who suffer migraines know that the pain can be excruciating.
Menstrual migraines, which can occur before, during or after a woman's period, are common, experts say. These migraines could be linked to a drop in estrogen and progesterone before the cycle begins. Estrogen controls chemicals in the brain that affect the sensation of pain.
Mays said migraines often decrease during pregnancy and after menopause, although this can vary. The frequency of migraines in men also generally decreases with age.
Popelar said her migraines now occur less frequently since she began paying closer attention to her diet and sleep patterns, getting regular exercise and taking over-the-counter medication such as Excedrin at the first sign of a migraine.
She said she usually experiences "aura migraines" that have symptoms such as blurred vision and extreme sensitivity to light.
Mays warns that people who experience frequent migraines should be careful - too much of over-the counter painkillers can cause "rebound migraines." She said those who suffer more than two migraines a month should see a doctor to discuss prescription medications.
Several types of antidepressants, anti-seizure medications and even Botox have been shown to decrease migraine frequency and intensity.
A class of medications called "selective serotonin receptor agonists" can help by narrowing blood vessels in the head and stopping pain signals from being sent to the brain.
Oral contraceptives have mixed results on migraines, although pills with uniform hormone levels can reduce migraines for some women, experts say.
However, Mays said she generally advises female migraine patients against hormone-replacement therapy, as it generally shows no change or makes migraines worse.
She said keeping a migraine diary can reveal patterns or potential triggers.
Exercise, proper posture, a diet with natural foods, stress-relief activities and getting a good night's sleep can help relieve migraines, Mays said.