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Migraine in Women

Migraine is not only a debilitating disease affecting millions, it is a women’s health issue. Of the more than 36 million Americans afflicted with migraine, 27 million are women. Women suffer from migraine 3 times as often as men, making it one of the leading serious health problems affecting women.

Gender affects the experience of migraine itself.  Women report episodic pain (often of a longer duration) and chronic pain more frequently than men. There is much evidence connecting hormones to migraine, but not all migraines are hormonal. Recent research has found that women may be more susceptible than men to cortical spreading depression, a wave of brain excitation that is thought to lead to migraine.

Prevalence

  • During childhood, migraine is more prevalent in boys than in girls. But after the start of puberty, when estrogen influence begins, the prevalence rises in girls. Girls are more likely to have their first migraine during the year of menarche than at any other time in their lives.
  • After puberty, migraine in women increases until age 45 or so, when it begins to decrease.
  • Women suffer from migraine three times as often as men. In the U.S., 18% of women suffer compared to 6% of men.
  • 92% of women with severe migraine have headache-related disability. Of those who suffer, 25% have 4 or more severe attacks per month.

Many women find their migraine symptoms are affected by menstruation, hormonal contraception, pregnancy, and menopause. While research has yielded some educated guesses, scientists cannot say for certain what will happen in a particular woman – yet.

Menstrual Migraine

Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after menstrual onset. It is usually more severe and more difficult to treat than other types of migraine. 10-14% of American women get menstrual migraine. The vast majority of these women also have migraine at other times of the month. In the same woman, attacks of menstrual migraine may differ from other attacks in  duration, severity, symptoms, and response to treatment.  Estrogen itself is not the culprit. Hormonal fluctuations, and especially estrogen withdrawal, are thought to trigger the migraine. Menstrual migraine is generally treated with the same drugs that are used for other types of migraine. If a woman’s menstrual migraine is so severe that it doesn’t respond to these medications, hormonal contraceptives are sometimes considered as a treatment.

Hormonal Contraception

While birth control pills remain the most popular form of hormonal contraception, hormones can also be administered vaginally, by patch, or injection.  The impact of hormonal contraception on migraine varies from woman to woman. Some women with migraine find that they have fewer headaches, while others experience more pain, and some find there is no effect at all. Oral contraceptives can trigger a woman’s first migraine attack, especially if she has a family history of migraine. Contraceptives which reduce or eliminate periods are sometimes used to treat severe menstrual migraine. Women with migraine should be careful when choosing a hormonal contraceptive, and weigh the risks and benefits of a particular contraceptive with their doctor.

Pregnancy and Nursing

Migraine sufferers should discuss their pregnancy plans with their doctors. Migraine medications may impact the ability to conceive and may harm the fetus. 60% of pregnant sufferers find their migraines improve significantly in their first trimester and more than 75% find they improve or even disappear during the rest of their pregnancy. Unfortunately, this is not the case for everyone. 15% report their migraines worsen during the first trimester, and about 25% notice no change. Usually, sufferers return to their pre-pregnancy migraine patterns after they give birth. But, regular nursing may delay the return of migraines.

Menopause

The prevalence of migraine decreases significantly during menopause, when menstruation ends and hormones cease fluctuating. Migraines improve or go away entirely in 67% of sufferers. However, during perimenopause, with its intense hormonal fluctuations, migraines often worsen. Women who go through natural menopause often find their migraine symptoms improve dramatically, while women who experience a surgical menopause often suffer more. The effect of estrogen replacement therapy on migraine varies and cannot be predicted.

Later Life

The prevalence of migraine drops markedly after age 60 to 5% in older women. Only 2% of all sufferers have their first migraine after age 65. It is important to consult a doctor to explore the causes of headaches in later life to rule out other medical problems.



DISCLAIMER:
The information provided here should not be used for the diagnosis, treatment, or evaluation of any medical condition. The Migraine Research Foundation has made every effort to ensure that the information is accurate; however, we cannot warranty its reliability, completeness, or timeliness. © Migraine Research Foundation.

 

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