Migraines: Bigger headaches for women than men
Migraine can afflict men, women and children. But it is not an equal-opportunity disorder. Of those who suffer chronic crippling migraine attacks, the vast majority are women. They are as many as 85 percent, according to the Migraine Research Foundation.
“A researcher once said that ‘the femaleness of migraine is inescapable,’ ” says Elizabeth Loder, associate professor of neurology at Harvard Medical School and chief of the division of headache and pain at Brigham and Women’s Hospital. “It’s true. Migraine disproportionately affects women.”
A migraine is much more than just a terrible headache. To be sure, migraine typically involves a painful throbbing headache, most times on one side of the head, sometimes both. But it also is an incapacitating neurological disease with a wide range of symptoms, including visual disturbances, nausea and vomiting, dizziness, sensitivity to lights, noises, and scents, and — for some — temporary weakness on one side. Episodes can last for hours, sometimes even days.
About 25 percent of victims also experience “aura,” a collection of sensory disruptions, such as flashes of light, blind spots, or tingling and numbness in the hands and face. Moreover, migraine with aura in women under age 50 increases their risk of ischemic stroke, especially if they also smoke and use oral contraceptives.
Migraine affects 1 in every 7 adults globally, according to the World Health Organization. In the United States, nearly 40 million Americans suffer from them, including 28 million women and girls, according to the research foundation. Migraines costs the nation an estimated $78 billion per year, with women accounting for about 80 percent of direct medical and lost labor costs, according to a recent report from the Society for Women’s Health Research.
“We don’t have the answer for why migraines are more common in women than in men, but women are more susceptible to every pain condition than men,” says Janine Clayton, who directs the Office of Research on Women’s Health at the National Institutes of Health. “Also, women in pain are not always taken seriously. Women are perceived as excessively seeking help.”
Cindy McCain, widow of Sen. John McCain, R-Ariz., has spoken out about her experiences with migraine, and the frustration of getting doctors to take her debilitating headaches seriously.
“I saw many doctors who wrote me off as just being ‘overstressed,’ ” she said in one interview. “Their advice was to go home, relax and have a glass of wine.”
Since migraines affect young women and get better with age, they are most prevalent during a time when women are expected to be most productive at home and work. Because the pain is often worse with routine activity, “people tend to remain still, which has obvious detriments towards productivity,” says Mark W. Green, professor of neurology and anesthesiology and director of the Center of Headache and Pain Medicine at Mount Sinai’s Icahn School of Medicine. “They also get light and sound sensitivity, and it is difficult to work, or even function, under those conditions.”
Boys experience more migraine than girls before puberty, then the equation changes, with girls and women bearing the brunt of migraine until after menopause. The disorder then eases for most women.
For this reason, most experts believe that women’s fluctuating hormones are a major influence, especially when estrogen falls around the time a women has her menstrual period. Most attacks occur several days before or after menstruation.
Green thinks estrogen withdrawal is a major trigger.
“Around period and ovulation, and just after a delivery, levels drop precipitously, which can be a problem,” he says. “After menopause, when the levels of estrogen remain low — they don’t fall — most women improve. Estrogen falls increase the excitability of the brain cortex. Migraine is a condition where the cerebral cortex is more ‘excitable,’ often genetically, so that is one reason why.”