The Female Connection
Up until puberty, girls and boys experience migraine on a fairly equal footing. But once menarche (the start of menstruation) hits, girls outstrip boys three to one. In fact, up to 70 percent of women cite the onset of their period as a major migraine trigger.
This obviously indicates that hormonal changes are closely tied to migraine. But hormones aren't the sole reason that women experience more migraines than men.
Research being conducted by the UCLA Department of Neurology suggests that women have faster triggering mechanisms than men. Cortical spreading depression (CSD), a phenomenon that can be seen as waves of activity that spread across the brain's surface, has been shown to trigger both migraine headache and the frequently accompanying aura and visual symptoms. Animal studies have shown that female mice have a much lower threshold for cortical spreading depression, and that the particular brain activity leading to migraine is both easier to evoke and faster to spread in women. While there are certainly other factors involved in CSD, such as hormones, genetics, and environment, males consistently showed slower reaction and wave spreading. Further research may reveal this to be one of the chief reasons why more women than men are subject to migraines.
The American Migraine Study II, a population-based survey of 20,000 American households sponsored by the National Headache Foundation, found that 51 percent of women who met the clinical criteria for migraine remain undiagnosed. This was higher than the rate for men, which was 41 percent.
Female sex hormones — including estrogen and progesterone — have a major impact on how pain is mediated and perceived in women. By studying hormone levels in female migraineurs throughout the different phases of the menstrual cycle, researchers have determined that consistently high levels of estrogen and progesterone in the body are associated with a decrease in migraine frequency and severity. Conversely, migraine frequency appears to peak during the first three days of the menstrual cycle when these hormones are at their lowest levels.
Research has shown that the genetic predisposition to migraine appears to be relatively equal in men and women. This provides further evidence that hormones play a large role in the prevalence and course of migraine in women.
It's believed that estrogen also plays a role in regulating levels of serotonin in the body, the neurotransmitter (or brain chemical) that is most associated with migraine. Blood levels of serotonin fall during a migraine; estrogen appears to increase serotonin production and the uptake of the neurotransmitter by receptors in the brain. Estrogen may also boost the pain-relief capabilities of the central nervous system.
On the other hand, estrogen supplementation in the form of birth control pills appears to increase migraine frequency and intensity in some women with menstrual migraine. Why the apparent inconsistency? Women with consistently high estrogen levels or consistently low estrogen levels appear to be less prone to migraine attacks. Researchers theorize that it is probably large fluctuations of estrogen in the blood that promote migraine. As the normal menstrual cycle and the dosing formulation of a month's supply of many birth control pill preparations produce significant hormone fluctuations in a cyclic manner, it is not hard to understand the cyclic nature of the condition in women with menstrual-related attacks or pure menstrual migraine.
Estrogen isn't the only female sex hormone that affects migraine. Progesterone, and the chemicals it produces when it metabolizes, appears to inhibit certain pain pathways in the trigeminal nerves. Increased levels of this hormone just after ovulation seem to be associated with a decreased severity of migraine headache during this phase of the menstrual cycle.
Several studies have looked at the effect of sudden estrogen depletion in women who had been on a long-term course of estrogen supplementation. All were associated with an increase in migraine frequency once estrogen was discontinued. One study of sudden estrogen withdrawal in women undergoing in vitro fertilization found that an abrupt decrease in estrogen was associated with an 82 percent increase in migraine attacks.
Despite increased education and awareness of the condition, there is still a stigma associated with migraine. Women with migraine in particular may encounter stereotypes of the condition as “just a headache,” “all in their head,” or signs of hypochondria. It is well documented that female migraineurs experience a higher level of disability than their male counterparts, reporting longer and more severe head pain, spending more time in bed recovering, and experiencing more lost days of work and school.
In some cases, women have grown up with these false conceptions of migraine and may not seek diagnosis or appropriate care. Or, those people a woman works and socializes with and encounters throughout her day may have these preconceptions, impacting her selfesteem and quality of life. Even some health care providers may not be appropriately educated about migraines and therefore may either consciously or unconsciously perpetuate these unfounded stereotypes.
The media has not helped the situation. A 2006 review of U.S. newspaper coverage of migraine published in the journal
Despite an increase in available media channels, newspapers continue to be a trusted source of health care information. A survey from the Centers for Disease Control (CDC) found that newspapers and magazines are used more often as health news sources than other online and broadcast media.
The study looked at journalistic coverage of neurological diseases and conditions in the
Interestingly, those conditions with the highest incidence of stigmatizing language garnered the least overall press coverage, perhaps demonstrating that migraine remains poorly understood by the media and by the public it serves.