Migraine: Why do women suffer from it more often and more severely than men?

Migraine is much more than just a headache. It is a devastating disorder of the nervous system.

People who suffer from migraines experience severe throbbing pain, usually in one half 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 isolated dark and quiet rooms.

Migraines affect about 800 million people worldwide; in the U.S. alone, about 39 million, or about 12 percent of the population, have them regularly.

And most of them are women. Women get migraines three times more often than men. For women between the ages of 18 and 49, migraine is the leading cause of disability worldwide.

What’s more, studies show that women get migraine more often, and it is more disabling and long-lasting than men. Women are more likely to seek medical care and receive prescription migraine medications. And women who suffer from migraines often have mental health problems, including anxiety and depression.

As a board-certified neurologist specializing in headache treatment, I find the differences between male and female migraine sufferers fascinating. And some of the reasons for these differences may surprise you.

Migraine and hormones
There are several factors why men and women experience migraine attacks differently. Among them are hormones, genetics, activation or deactivation of certain genes – an area of study called epigenetics – and environment.

All of these factors play a role in shaping the structure, function and adaptability of the brain in relation to migraine. The hormones estrogen and progesterone, through a variety of mechanisms, regulate many biological functions. They affect various chemicals in the brain and may contribute to functional and structural differences in specific brain regions associated with the development of migraine.

In addition, sex hormones can rapidly alter the size of blood vessels, which may predispose to migraine attacks.

During childhood, boys and girls have the same chance of developing migraines. It is estimated that about 10 percent of all children will experience one at some point. But when girls reach puberty, their chances of getting migraines increase.

This is 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 the time of their first menstrual cycle. But migraine is most common and most pronounced during a woman’s reproductive and childbearing years.

Researchers estimate that about 50 to 60 percent of women with migraine experience menstrual migraine. This migraine usually occurs a few days before or during menstruation, when decreased estrogen levels can trigger migraine attacks. Menstrual migraine can be more severe and longer lasting than migraine on other days of the month.

In the 1990s, a class of medications, triptans, emerged that are widely used to treat migraine; some can be used specifically for menstrual migraine.

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