Why do females experience a higher incidence of migraine headaches compared to males?

**Understanding Migraines: Gender Differences and Hormones**
A migraine is not just a headache – it’s a debilitating disorder that affects the nervous system. People who suffer from migraines experience severe throbbing or pulsating pain, usually on one side of the head. Along with the pain, migraines are often accompanied by nausea, vomiting, and extreme sensitivity to light or sound. Attacks can last for hours or even days, causing sufferers to seek relief in dark, quiet rooms. Worldwide, approximately 800 million people get migraines, with about 39 million, or roughly 12% of the U.S. population, experiencing regular migraines. Interestingly, the majority of migraine sufferers are women, with more than three times as many women as men experiencing migraines. Migraine is also the leading cause of disability for women aged 18 to 49. Research has shown that not only are women more likely to seek medical care and prescription drugs for migraines, but they also tend to experience more frequent, disabling, and longer-lasting migraines compared to men. Women with migraines are also more likely to have mental health issues such as anxiety and depression. The gender differences in migraines are intriguing, and understanding the reasons behind these differences can help improve treatment and management of migraines in both men and women.

**Hormones and the Impact on Migraines**
Several factors contribute to the different ways men and women experience migraines, including hormones, genetics, epigenetics (gene activation or deactivation), and the environment. Hormones, specifically estrogen and progesterone, influence many biological functions and can affect various chemicals in the brain. They may contribute to differences in the structure, function, and adaptability of the brain regions involved in migraines. Additionally, sex hormones can influence the size of blood vessels, making individuals more prone to migraines. While boys and girls have an equal chance of experiencing migraines during childhood, the likelihood of getting migraines increases for girls during puberty. Fluctuating levels of sex hormones, particularly estrogen, associated with puberty, are believed to be the primary cause. Some girls even experience their first migraine around the time of their first menstrual cycle. Migraines are most common and intense during a woman’s reproductive and child-bearing years. Approximately 50% to 60% of women with migraines experience menstrual migraines, which occur in the days leading up to or during menstruation when estrogen levels drop. These migraines can be more severe and longer-lasting than migraines at other times of the month. Triptans, a class of medications developed in the 1990s, are commonly used to treat migraines, including menstrual migraines. Certain nonsteroidal anti-inflammatory drugs and birth control methods that regulate hormone levels can also be effective.

**Migraine with Aura and Hormonal Contraceptives**
Women who experience migraines with aura, a distinct type of migraine, should generally avoid using hormonal contraceptives that contain estrogen. The combination of estrogen and aura can increase the risk of stroke due to the promotion of blood clot formation. Progesterone-only birth control pills, the Depo-Provera shot, and intrauterine devices are safer options for women with migraines with aura. Migraine with aura affects approximately 20% of migraine sufferers. Symptoms typically begin with dark spots and zigzag lines in the person’s vision and may also include difficulty speaking clearly or tingling and weakness on one side of the body. These symptoms gradually build up over minutes and are followed by head pain. Although these symptoms resemble those of a stroke, the slow onset differentiates migraines with aura from strokes. However, it can be challenging for non-medical individuals to distinguish between the two conditions during an attack, making a call to emergency services the most prudent option if there is any uncertainty.

**Migraines During Pregnancy and Menopause**
Migraines can be particularly debilitating for pregnant women, especially during the first trimester when morning sickness is common. Difficulty eating, sleeping, or staying hydrated can make migraines more likely. The good news is that migraines generally decrease in severity and frequency as the pregnancy progresses, and for some women, they may disappear entirely. However, for those who experienced migraines during pregnancy, they tend to increase after delivery due to decreasing hormone levels and other environmental factors related to caring for an infant. Migraine attacks can also increase during perimenopause, the transitional phase to menopause. Fluctuating hormone levels, particularly estrogen, trigger migraines at this time along with other symptoms such as chronic pain, depression, and sleep disturbances. As menopause progresses, migraines typically decline and may even disappear. Hormone replacement therapy, which contains female hormones, can help reduce the frequency and severity of migraines throughout menopause.

**Migraines in Men**
While migraines are more prevalent in women, the frequency and severity of migraines slightly increase in men during their early 20s. This increase is followed by a peak around age 50, after which migraines slow down or stop altogether. The reasons behind this pattern are not well understood, but genetic factors, environmental influences, and lifestyle choices likely contribute to the rise and fall of migraines in men.

**Bridging the Gender Gap in Migraine Research**
Understanding the gender differences in migraines is crucial for empowering women and advancing the overall knowledge and management of the condition. By studying migraines in both men and women, researchers can uncover the underlying causes and improve treatment options for all sufferers.