Author: Zia Sherrell, MPH
Migraine can affect anyone, but it is more common in females. Compared with males, females are three to four times more likely to experience migraine.
This statistic comes from a paper in the journal Frontiers in Neurology.
The reasons that migraine is more common in females are not entirely clear. That said, scientists believe that it may have something to do with hormonal fluctuations that take place during the menstrual cycle.
However, migraine is a complex condition, and it does not have a single cause. Hormonal changes may be one of many factors that contribute to a migraine episode.
This article explores the causes of migraine in females, the link between migraine and hormones, and migraine triggers.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth.
Migraine is a complex neurological condition that causes episodes of head pain. These episodes are sometimes accompanied by other symptoms, such as nausea and sensitivity to light or sound.
Around 20% of people with migraine also experience aura, which refers to temporary sensory disturbances that occur before the headache.
Previously, scientists thought migraine resulted from the dilation of blood vessels in the head, creating pressure and pain. Now, they know that this is not the case.
Research suggests that migraine occurs due to a cascade of changes that take place in the nervous system and brain, which can begin up to 3 days before the headache itself.
One 2018 review explains that this begins with changes in the hypothalamus, limbic system, and cortical areas of the brain. Then, in the aura phase, people may experience something similar to cortical-spreading depression, which is when nerves in the brain become temporarily inactive.
Then, in the headache phase, the trigeminovascular system activates. This system includes the trigeminal nerve. This nerve reaches around the side of the head, including behind the eye, which is a common site of migraine pain.
There is no single cause of migraine. Scientists believe that it happens, in part, due to genetics. This means that people with a family history of migraine may be more susceptible to developing it themselves.
There is also evidence to suggest that several chemicals in the brain, such as calcitonin gene-related peptide, are involved in the development of migraine. These factors can apply to anyone, regardless of sex.
However, females are three to four times more likely to have migraine than males. This is only true after puberty. Before puberty, the incidence of migraine among sexes is the same.
Some potential reasons for this include:
- Hormones: After puberty, most females begin the menstrual cycle, which involves monthly fluctuations in hormones such as progesterone and estrogen. These hormones may affect the nervous system and brain, making migraine more likely.
- Stress: Stress can be a migraine trigger. Some researchers believe that this is because stress increases inflammation in the body. This may have a stronger impact on the development of migraine in females than in males. Previous animal studies in male and female rats have shown that stress caused higher inflammation levels in the females. However, more research on this is necessary.
- Impact of genes: So far, scientists have identified 38 genetic variations that may be involved in migraine. Some evidence suggests that these variations may impact males and females differently.
Scientists are not sure exactly how sex hormones and migraine are related. One 2020 review notes that there have been several flaws in previous research on this subject, which makes it difficult to understand the connection.
Firstly, most research into the role of sex hormones in migraine has focused on male animals. This means that there is less information about how migraine affects female animals.
Secondly, a lot of previous research has not clearly distinguished between sex and gender. Sex is based on biological characteristics, while gender is based on identity. This makes it difficult to know the extent to which sex-based differences, such as the menstrual cycle, are responsible for migraine in females.
High estrogen levels may increase the risk of migraine with aura by raising the chance of cortical-spreading depression. This may explain why oral birth control pills that contain estrogen make migraine worse for people who experience aura.
Estrogen may also interact with specific nerves, making them more sensitive to migraine triggers. Research from 2018 suggests that although testosterone has a protective effect, estrogen increases sensitivity in the cells of the trigeminal nerve.
An older theory suggested that falling estrogen levels after ovulation might be responsible for an increase in migraine episodes before menstruation. However, not all researchers agree with this theory.
Although hormonal changes can trigger migraine, there are many other factors that can contribute. According to the American Migraine Foundation, these include:
- Stress: Almost 70% of people with migraine find that stress can trigger an episode. If an individual is anxious about experiencing a migraine episode, it can begin a cycle of stress, leading to further headaches.
- Sleep: If a person’s sleep schedule is irregular, they can be more prone to episodes. However, almost 50% of migraine episodes happen between 4 a.m. and 9 a.m., which can put people with migraine at higher risk of sleep disorders. Breaking this cycle with medications or other management strategies may help.
- Caffeine and alcohol consumption: A person may find that consuming coffee can trigger a migraine episode. However, some people claim that coffee can stop their symptoms. Alcohol consumption can also trigger a migraine episode.
- Weather: Changes in barometric pressure with excessive heat or storms may trigger migraine episodes for some people.
- Diet: Some people find that certain foods and ingredients — such as cheese, chocolate, and artificial sweeteners — can trigger migraine episodes.
- Dehydration: Around 1 in 3 people list dehydration as a migraine trigger. Dehydration causes adverse effects throughout the body and may cause dizziness and confusion in addition to migraine symptoms.
- Bright light: Some individuals find that natural light affects their migraine. Others find that artificial, bright, or flickering lights can be more problematic.
- Smells: Certain smells can activate nerve receptors in the nose, triggering or worsening a migraine episode.
Treatment for migraine in females is usually the same as treatment for people of any sex.
Over-the-counter (OTC) anti-inflammatory medications, such as ibuprofen or aspirin, are a common first step. If these do not work, a doctor may prescribe other migraine drugs, such as triptans.
However, there are some additional treatment options that may help females with migraine that is related to their menstrual cycle. These options include:
- Combined contraceptives: Combined contraceptives contain both estrogen and progesterone. Some people may find that by reducing the drastic changes in their hormone levels during the menstrual cycle, these medications reduce migraine episodes. However, it is important to note that people who experience migraine with aura cannot take estrogen.
- Progesterone-only contraceptives: These are alternatives to combined contraceptives. They work by stopping ovulation and the hormonal changes that come with it without the use of estrogen.
- Estrogen supplementation: This option can include patches and topical gels or creams that contain estrogen. Using these products after ovulation may prevent a dip in estrogen levels, which could help some people avoid migraine episodes.
- Magnesium: An individual can take magnesium supplements as a form of preventive treatment. They can start taking them on day 15 of their menstrual cycle and continue doing so until their next period.
It is essential for a person to work with a doctor to create a treatment plan that suits them. Typically, doctors recommend trying medications and other strategies before hormonal approaches, as these may carry additional risks.
Various conditions may resemble migraine, including:
- tension headache
- cervicogenic headache, which occurs due to the compression of nerves in the spine
- cluster headache, which causes intense pain and burning around the eyes
- primary stabbing headache (or ice-pick headache), which causes sudden, intense, and sharp pain that may last for only 5–30 seconds at a time
Sometimes, the symptoms of migraine aura can also be similar to those of a stroke. For this reason, it is important to speak with a doctor about any migraine-like symptoms so that they can provide an accurate diagnosis.
Migraine is more common among adult females than males. Scientists are not sure why this is the case.
One of the main risk factors for migraine in all people is genetics. However, in females, there may be additional factors that make the condition more common.
For example, rising or falling estrogen levels may explain why females are more likely to experience migraine. It is also possible that social factors, such as stress and anxiety, contribute to the condition.
For migraine episodes that seem to be connected to the menstrual cycle, doctors can provide treatments to regulate hormone levels and reduce episodes.