Why do women have more and worse migraines than men?: this is how a neurologist explains it

Migraine is much more than a headache, it is a debilitating nervous system disorder.

People with migraines experience throbbing or throbbing pain, usually 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 ease the suffering, some people spend time in isolation in dark rooms.

About 800 million people around the world have migraines. In the United States alone, about 39 million people, about 12% of the population, are regularly affected.

And that’s most of these people 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 worldwide.

In addition, research shows that migraines are more common, more disabling, and longer lasting in women than in men.

Women are more likely than men to seek medical help and medications to treat migraines. And women with migraines often have more psychological problems, including anxiety and depression.

As a board-certified headache neurologist, I find the gender differences in migraine headaches 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 the hormones, genetics and how certain genes are turned on or off, called an area of ​​study epigenetics and the environment.

All of these factors play a role in shaping the brain’s structure, function, and adaptability when it comes to migraines.

The hormones estrogen and progesterone play a role in the regulation of many biological functions through different mechanisms.

These affect various brain chemicals and may contribute to functional and structural differences in specific brain regions involved in migraine development.

In addition, sex hormones can quickly change the size of the penis blood vesselswhich 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 get migraines at some point.

But as girls hit puberty, the risk of migraines increases.

That’s because of the fluctuating levels of sex hormonesmainly estrogen, associated with puberty, although other hormones, including progesterone, may also play a role.

Some girls get their first migraine around their first menstrual cycle.

But migraines are more common and more intense during a woman’s reproductive cycle and during the childbearing years.

Researchers estimate that approx 50% to 60% of women with migraines experience menstrual migraines.

These migraines usually occur in the days leading up to menstruation or during the period 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, are commonly used to treat migraines. Certain triptans can be used specifically to treat menstrual migraines.

Another class of medications called nonsteroidal anti-inflammatory drugs has also been effective in reducing the discomfort and duration of menstrual migraines.

The same goes for birth control methods, which help keep hormone levels stable.

migraine with aura

But the women who have migraine with aurawhich is another type of migraine, should generally avoid the use of estrogen-containing hormonal contraceptives.

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 for a synthetic variant of progesterone), and IUDs.

Migraine with aura effect over the twenty% of people with migraines. Usually, before the migraine, the person sees most of the time black dots and zigzag lines.

Less commonly, about 10% of the time, there is an inability to speak clearly, or there may also be tingling and weakness on one side of the body.

These symptoms progress slowly, usually last less than an hour before disappearing, and are usually followed by a headache.

While these symptoms are similar to those of a stroke, the aura tends to come on slowly, over the course of a few minutes, while a stroke is instantaneous.

That said, it can be difficult and dangerous for someone without medical knowledge to try to tell the difference between the two conditions, especially during an attack, and determine whether it’s a migraine with aura or a stroke.

When in doubt about what is going on, it is wisest to call the emergency service.

Migraine during pregnancy and menopause

For women who are pregnant, migraines can be particularly debilitating during the first trimesterwhen morning sickness is common, making it difficult to eat, sleep, or drink.

Even worse, skipping any of these things can make migraines more likely.

The good news is that migraines generally become less severe and frequent during the rest of pregnancy. In some women, they disappear, especially as the pregnancy progresses.

But for those who get them during pregnancy, migraines tend increase after delivery.

This could be due to a drop in hormone levels, as well as lack of sleep, stress, dehydration, and other environmental factors related to caring for the baby.

Migraine attacks can also increase during perimenopause, the transitional phase to menopause.

Again, it’s fluctuating hormone levels, especially estrogen, that cause them, along with the chronic pain, depression, and sleep problems that can set in around this time.

However, as menopause progresses, migraines decrease. In some cases, they disappear completely.

Meanwhile, there are treatments that can reduce both the frequency and severity of migraines during menopause, including hormone replacement therapy.

Hormone replacement therapy contains female hormones and is used to replace the hormones that the body produces in smaller amounts during menopause or after menopause.

migraines in men

The frequency and severity of migraines increases slightly for men after the age of 20. They reach their peak around age 50, then they are reduced or disappear completely.

It is not known exactly why it happens this way, but a combination of genetic factors, environmental influences and lifestyle may contribute to the increase.

Researchers still have a lot to learn about why women and men get migraines.

Bridging the gender gap in migraine research not only empowers women, but also increases understanding of the condition as a whole and creates a future where migraines can be better managed.

*Danielle Wilhour is Professor of Neurology, University of Colorado, Anschutz Medical Campus, United States.

*This article was published on The Conversation and reproduced here under the Creative Commons license. Click here if you want to read the original version (in English)

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