According to the American Headache Society Committee, up until puberty, boys and girls report the same rate of migraines. After puberty, however, the numbers change significantly. For girls, the big change that happens at puberty is that their bodies begin to have fluctuations of estrogen as they move through their menstrual cycles. Estrogen is believed to be the primary explanation for why women have more migraines than men. Women often have hormonal migraines right before or during their periods, when estrogen levels drop. As many as 60 to 70 percent of women who get migraines report that their monthly cycle is related to when they get migraines [source: The Cleveland Clinic]. Dr. Marcia Whalen, D.O., a physician for the U.S. Olympic Training Center in Colorado Springs, says, "Some migraines can be associated with the changing levels of estrogen throughout the menstrual cycle, thus making women more susceptible to this particular type of migraine."
Hormonal contraceptives, in patch or pill form, and hormone replacement therapy (HRT), used to treat menopausal symptoms, can worsen or improve hormonal migraines. Doctors can adjust patients' dosage until the birth control pills either have no effect on or relieve migraine symptoms. According to The Cleveland Clinic, another approach is to prescribe a continuous pill so the patient does not have a menstrual period or experience a drop in estrogen. The information about hormones and menstrual migraines is important, but are there other differences between men and women that impact migraines?
Although hormones are important for understanding migraines in women, many physicians believe that migraines can be triggered by underlying central nervous system disorders and that certain triggers bring on the pain, causing the release of neuropeptides, or brain chemicals. Another theory is that the maxillary nerve, the nerve that runs behind the cheekbone, can become inflamed. Nitric oxide has also been named as a cause. If the neurons in the brain release too much nitric oxide, it activates nerve pathways in the brain, causing pain [source: The National Migraine Association].
Dr. Sperber points out that "Migraine pain is now thought to be primarily a disorder of cortical and brainstem excitability." Some migraine sufferers see auras, where they may experience zig-zagging lines or even loss of sight in some areas, just before they get their headaches. There's evidence that these auras are linked to brain excitability, essentially a brain that is working too hard, called cortical spreading depression (CSD) [source: Nature Medicine]. CSD creates short-lasting waves that move across the brain, creating inflammation in the brain and causing pain. The brain experiences excitation followed by nerve cell depression - the blood flow increases, then decreases. This change in pressure in the brain is what causes migraine pain. There is evidence that women are more sensitive to the effects of CSD, and that this explains why more women experience migraines than men.
Blocking CSD can create relief for some migraine sufferers. A drug called memantine is being studied for its CSD blockage properties. Migraine sufferers can also take pain-relieving medications or take drugs known to help prevent migraines such as beta blockers, antidepressants, Botox and even anti-seizure drugs. Follow the links on the next page to learn more about migraines.