A migraine is much more than a headache, it is a debilitating disorder of the nervous system.
People who have migraines experience throbbing or pulsating pain, typically on one side of the head. The pain is often accompanied by nausea, vomiting and extreme sensitivity to light or sound.
An attack can last for hours or days, and to alleviate suffering, some people spend time in isolation in darkened rooms.
About 800 million people worldwide have migraines. In the United States alone, about 39 million people, approximately 12% of the population, suffer from them regularly.
And, the majority of these people are women. More than three times as many women as men have migraines.
For women between the ages of 18 and 49, migraine is the leading cause of disability in the world.
What’s more, research shows that women’s migraines are more frequent, more disabling and last longer than those of men.
Women are more likely than men to seek medical care and drugs to treat migraines. And women with migraines tend to have more mental health problems, including anxiety and depression.
As a board-certified neurologist specializing in headaches, I find the gender differences regarding migraine fascinating. And, some of the reasons for these differences may surprise you.
Migraines and hormones
There are several factors that explain why men and women experience migraine attacks differently.
These include hormones, genetics and how certain genes are turned on or off-an area of study called epigenetics-and the environment.
All of these factors play a role in shaping the structure, function and adaptability of the brain when it comes to migraines.
The hormones estrogen and progesterone, through various mechanisms, play a role in regulating many biological functions.
They affect various chemicals in the brain and may contribute to functional and structural differences in specific areas of the brain that are involved in the development of migraines.
In addition, sex hormones can rapidly change the size of blood vessels, which can predispose people to migraine attacks.
In childhood, both boys and girls are equally likely to develop migraines. It is estimated that about 10% of all children will have a migraine at some point.
But when girls reach puberty, the chances of getting migraines increase.
That’s due to fluctuating levels of sex hormones, primarily estrogen, associated with puberty, although other hormones, including progesterone, may also be involved.
Some girls have their first migraine around their first menstrual cycle.
But migraines tend to be more frequent and intense during a woman’s reproductive cycle and during childbearing age.
Researchers estimate that between 50% and 60% of women with migraines experience menstrual migraines.
These migraines typically occur in the days leading up to menstruation or during menstruation itself, when decreased estrogen levels can trigger migraines.
Menstrual migraines can be more severe and last longer than migraines at other times of the month.
A group of drugs that came on the market in the 1990s – the triptans – is generally used to treat migraines. Certain triptans can be used specifically to treat menstrual migraines.
Another category of medications, called nonsteroidal anti-inflammatory drugs, have also been effective in reducing the discomfort and duration of menstrual migraines.
The same is true of birth control methods, which help keep hormone levels stable.
Migraines with aura
But women who have migraines with aura, which is a different type of migraine, should generally avoid using hormonal contraceptives containing estrogen.
The combination may increase the risk of stroke because estrogen may increase the risk of blood clots.
Birth control options for women with migraines with aura include progesterone-only birth control pills, Depo-Provera injections (the brand name of a synthetic variant of progesterone), and intrauterine devices.
Migraines with aura affect about 20% of people who have migraines. Typically, before the migraine, the person usually sees black dots and zizag lines.
Less frequently, about 10% of the time, there is an inability to speak clearly, or tingling and weakness on one side of the body.
These symptoms increase slowly, usually last less than an hour before disappearing, and tend to be followed by headache.
Although these symptoms resemble those of a stroke, the aura tends to occur slowly, over a few minutes, while the stroke occurs instantaneously.
That said, it can be difficult and dangerous for a person without medical knowledge to try to differentiate the two conditions, especially in the midst of an attack, and determine whether it is a migraine with aura or a stroke.
If there is any doubt as to what is going on, the wisest thing to do is to call the emergency department.
Migraine headaches during pregnancy and menopause
For women who are pregnant, migraines can be particularly debilitating during the first trimester, when morning sickness is common, making it difficult to eat, sleep or hydrate.
Worse, skipping any of these things can make migraines more likely.
The good news is that migraines generally tend to become less severe and frequent during the remainder of pregnancy. For some women they go away, especially as pregnancy progresses.
But, for those who suffer during pregnancy, migraines tend to increase after delivery.
This may be due to a reduction in hormone levels, as well as lack of sleep, stress, dehydration and other environmental factors related to caring for the baby.
Migraine attacks may also increase during perimenopause, the transitional phase toward menopause.
Again, it is the fluctuation of hormone levels, particularly estrogen, that causes them, along with the chronic pain, depression and sleep problems that can occur in this period.
However, as menopause progresses, migraines tend to reduce. In some cases, they disappear completely.
In the meantime, there are treatments that can decrease both the frequency and severity of migraines during menopause, including hormone replacement therapy.
Hormone replacement therapy contains female hormones and is used to replace those that the body produces less of during the transition or after menopause.
Migraine headaches in men
The frequency and severity of migraines increases slightly for men from the age of 20. They peak around the age of 50, then decrease or disappear completely.
It is not known exactly why it happens this way, but a combination of genetic factors, environmental influences and lifestyles may contribute to the increase.
Researchers still have much to learn about why women and men suffer from migraines.
Bridging the gender gap in migraine research not only empowers women, but also advances knowledge of the condition as a whole and creates a future in which migraines can be better managed.
*Danielle Wilhour is professor of neurology, University of Colorado, Anschutz Medical Campus, USA.