Migraines - Why Are Women More Likely To Suffer?

Migraine, which is the seventh most prevalent medical disease and the second most disabling neurological condition in the world, is an episodic primary headache that is often characterized by intense, throbbing, and pulsatile headache attacks in one side of the head. It often lasts for 4–72 hours, and is frequently accompanied by nausea, vomiting, photophobia (light sensitivity), and/or phonophobia (sound sensitivity).There are several types of migraine, including:

  • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights.

  • migraine without aura – the most common type, where the migraine happens without the specific warning signs.

  • migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.

  • Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. Yet one thing for certain is that they are debilitating when they do occur.

There are a number of theories as to what an trigger migraines, including:

  • Food allergy or intolerance

  • Food components including histamine and tyramine

  • Alcohol and caffeine

  • Food additives include MSG, nitrates and aspartame

  • Blood sugar imbalance

  • Helicobacter pylori

  • Gut dysbiosis

  • Toxin overload or suboptimal detoxification

  • Stress

  • Genetics

Another theory which has started to receive more attention recently is the influence of sex hormones on migraines.

The prevalence of migraine in women is up to three times higher than in men, with 1 in 5 women affected and 1 in 15 men. Although a peak of incidence appears in individuals in the age range of 25–55 years in both genders, this remains higher in women. It has also been reported that women experience more frequent, longer-lasting, and more intense attacks than men. This could be due to the differences in sex hormones with oestrogen being the primary sex hormone of interest.

The term ‘oestrogen’ is used to collectively describe the metabolites which play a major role in women’s reproductive function, and a minor one in men’s. Oestradiol is the most potent and the other important, but less powerful oestrogens, are oestrone and oestriol.In non-pregnant women, oestrogens are produced primarily by the ovaries and in smaller quantities by adipocytes (fat cells), the liver, adrenal glands and breasts. In men, oestrogen is synthesized from its precursors, androstenedione and testosterone, by aromatization. You’ve probably heard of oestrogen dominance whereby oestrogen can be elevated in relation to progesterone, specific types of oestrogen or its metabolites can be elevated, or cells are more sensitive to oestrogenic signalling.

This can result in a range of symptoms and conditions including PMS, heavy periods, endometriosis, fibroids and even certain cancers. However oestrogen can also be too low, which is commonly associated with the menopause, but it can also be experienced by females at other times in their lives. Low oestrogen can be associated with irregular periods or absence of periods and even low libido, fatigue, poor skin integrity, hair loss and the depressive form of PMS.

Is oestrogen the cause?

Naturally oestrogen and progesterone fluctuate throughout the menstrual cycle and this seems related to changes in migraine frequency and/or intensity. Menstrual related migraine has been reported in more than 50% of women with migraine. It is reported that there is an increased risk in women to suffer a migraine episode between 2 days before and 3 days after menstruation, which could be related to the lowest concentration of oestrogen and progesterone. More specifically peri-menstrual oestrogen withdrawal seems to be a trigger for migraine without aura. A drop in oestrogen may cause an increased sensitivity to prostaglandins. Prostaglandins are hormone-like substances that are involvedthe dilation and constriction of blood vessels, and modulation of inflammation.

This increased sensitivity can result in a release of neuropeptides such as calcitonin gene-related peptide (CGRP), substance P and neurokinins which could result in neurogenic inflammation causing pain. Interestingly, during pregnancy, when oestrogen and progesterone are 10 times higher than in non-pregnant states, an improvement in migraine is reported, especially in women suffering from menstrual-related migraine. This certainly highlights the involvement of oestrogens in women with migraines.

However unfortunately sex hormones are complicated and this relationship is inconclusive as while there are studies reporting that low levels of oestrogens may be related to an increase in the number of migraine attacks, others suggest that the application of oestrogens promote migraine episodes. Many women with migraines are often prescribed the oral contraceptive pill (OCP) but for many this doesn’t work, may worsen migraines, and it also doesn’t get to the root cause as to why the migraines are occurring.

Next week we will have an article from one my of clients Beth, she suffer's from chronic daily headache syndrome, she will be sharing her experience and how she's learned to flourish through her migraine journey.