Why do women have more migraines than men?

Migraine pain can be agonizing for many women -- men too. Yet far fewer men experience these intense headaches. Why is that?
Migraine pain can be agonizing for many women -- men too. Yet far fewer men experience these intense headaches. Why is that?
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Your head is pounding with a pulsating headache. You feel nauseous, and you may even vomit. Light and sound are unbearable. In fact, any little noise or ray of light creates blinding pain and sends you back to bed to hide away in a dark room where you just want to be left alone. The pain is extremely intense, and it can go on for hours or even days in some cases. Often it repeats itself -- sometimes a week later, sometimes a month later. Sounds pretty miserable, doesn’t it?

These are the symptoms of a migraine, and if you’re a woman, you’re nearly three times more likely to have them than a man. According to the Mayo Clinic, 17 percent of women have migraine pain, while only 6 percent of men do. These statistics are the basis for the question -- why do women have more migraines than men?

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The list may seem long, but everyone is sensitive to different things. In fact, these are just some of the more common triggers. One person might be sensitive to alcohol but have no problem with caffeine, while another might have terrible migraines from caffeine and a higher tolerance for alcohol. People are also responsive to different triggers at different times. For instance, one day, bright light may not affect you at all, while on another day, it could immediately set off a migraine.

If you do have migraine pain, it’s a good idea to keep a journal. In this way, you'll be able to track your possible triggers. Who knows? You may be surprised by the results of your own record keeping. Of course, you should always consult a doctor about any migraine or severe headache pain you experience.

Up next, find out if women are more sensitive to migraine triggers than men. Also, do genetics have anything to do with this? Read on to find out.

Migraine Pain Sensitivity

Men and women react differently to pain -- it's biological.
Men and women react differently to pain -- it's biological.
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Women may be more susceptible or sensitive to migraine triggers than men. Dr. Kevin Sperber, assistant professor of Clinical Rehabilitation Medicine at Columbia University College of Physicians and Surgeons in New York City, says. "I don't know of any research specifically comparing the sensitivity of men and women with migraines to specific triggers; however, for dietary and pharmacologic triggers (such as caffeine or alcohol), the same dose will affect men and women differently." For one thing, women tend to be smaller than men, so the same amount of alcohol is likely to affect a woman more than a man. Women also metabolize alcohol, caffeine and other foods and chemicals differently, which may further explain their increased sensitivity.

To date, there are no studies that show that men and women cope with migraines differently. However, Dr. Desiree Thomas, a neurologist at Kelsey-Seybold Clinic in Houston, Texas, says that there is research which shows "differences in how the brains of men and women process pain information." So while a woman might be in bed with the shades drawn coping with a migraine, a man might not be as dramatically affected by the same symptoms simply because his brain handles the pain signals differently. It's not true that men are just tougher. Instead, women and men's brains are wired differently when it comes to processing and reacting to pain.

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Family history is another important factor in migraine activity. If you have relatives with migraines, then you're more likely to have them, too. The closer the relative is to you and the more relatives you have with migraines, the more likely you will be susceptible to them as well. There's a definite genetic link when it comes to migraines, which further supports the idea that there's more to it than just women being weaker than men or women responding to triggers differently.

So is there a physical difference in a woman's body that makes them more susceptible to migraines? Keep reading to find out how hormones and brain activity affect women.

Hormonal Migraines

Estrogen is believed to be the primary explanation for why women have more migraines than men.
Estrogen is believed to be the primary explanation for why women have more migraines than men.
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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?

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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].

Hormones aren't the only source of migraine pain in women.
Hormones aren't the only source of migraine pain in women.
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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.

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Sources:

  • An interview with Dr. Desiree Thomas, Neurologist at Kelsey-Seybold Clinic in Houston.
  • An interview with Dr. Kevin Sperber, Assistant Professor of Clinical Rehabilitation Medicine at Columbia University College of Physicians and Surgeons in New York City.
  • An interview with Dr. Marcia Whalen, D.O., Physician for the U.S. Olympic Training Center in Colorado Springs.
  • Guiou, Sheth, Nemoto, Walker, Pouratian, Ba, Toga. "Cortical spreading depression produces long-term disruption of activity-related changes in cerebral blood volume and neurovascular coupling." Journal of Biomedical Optics. 2005. (June 2008) http://www.ncbi.nlm.nih.gov/pubmed/15847570
  • Iadecola, Constantino. "From CSD to Headache: A Long and Winding Road." Nature Medicine. 2002. (June, 2008) http://www.nature.com/nm/journal/v8/n2/full/nm0202-110.html
  • Lauritzen, Martin. "Pathophysiology of the migraine aura: The spreading depression theory." Brain: A Journal of Neurology. Vol. 117, no. 1, pp. 199-210. 1994. (June 2008) http://brain.oxfordjournals.org/cgi/content/abstract/117/1/199
  • The Cleveland Clinic. "Hormone Headaches/Menstrual Migraines." 8/30/2006. (June 2008)http://my.clevelandclinic.org/disorders/migraine_headache/hic_hormone_headaches-menstrual_migraines.aspx