Women and Headaches

Pain expert Dr. Scott Fishman answers questions about headache pain:

Q: Why do women get more headaches than men?


A: While it is true that women get more headaches than men, the usual explanation that they are caused by hormones does not answer the question. Men have hormones too (even a little estrogen in their systems) and women have a touch of the male hormone testosterone. So the hormone answer does not fill in all the blanks.

However, the fact that women have more headaches has for years stirred research into causes and new treatments. For a long time, scientists and researchers ignored headaches as a legitimate subject of study. They were dismissed as a "woman's problem" and so relegated to the realm of a psychological disturbance. The discovery of a new class of headache drugs, the triptans, which work on brain chemistry, has helped to push headache research into mainstream science.

"The new drug sumatriptan changed the way doctors think about migraines," says Dr. Elizabeth Loder, Director of the Headache Management Program at Spaulding Rehabilitation Hospital in Boston. "They became a real medical condition that could be treated, not just a woman's problem."

That said, there is such a creature known as a hormonal headache that strikes women. I tell the story in The War on Pain about a woman in her forties who had been having migraines since the age of five. During her childhood, they were limited to about two a year. She was able to eliminate more attacks by identifying and avoiding her personal headache triggers: bright sun, loud noise, exercise, and aged cheese.

During her twenties, thirties and early forties, the headaches came more often and more severely. The woman also found that her grandmother, mother, and aunt had suffered the same headache history. They finally disappeared when the women reached menopause.

During her peak headache years, this woman tried an assortment of treatments: biofeedback, intensive group therapy, acupuncture, stress reduction, the herb feverfew, as well as various drugs. Her headache specialist, Dr. Zahid Bajwa, Director of the Headache Center at the Beth Israel Deaconess Hospital in Boston, devised a two-pronged treatment focused on prevention and cutting off headaches when they flared up.

He started her on the antidepressant amitriptyline (brand name Elavil), not because he thought she was depressed, but because the drug alters the activity in brain chemicals that play a part in migraines.

For prevention, he prescribed another medication, and for sudden pain, he gave her the new-generation triptan, Maxalt. Despite all the treatments available, Dr. Bajwa said that true relief may only come with age and menopause.