Migraine attacks are These aren’t just headaches. They can cause intense pain and sickness that last for hours or even days, making it impossible to do anything but rest in a murky, serene room. And for millions of women, these devastating attacks aren’t just an occasional experience, but a recurring ordeal.
Women suffer from migraines three times more often than menwith episodes that are more prolonged and intense. “It’s much more common than most people realize,” says Anne MacGregor, a headache and women’s health specialist. Despite treatment options, migraines remain leading cause of disability-adjusted life years (DALY) — a measure of the burden of disease that takes into account time lost due to impoverished health — for women aged 15 to 49. While there is still some mystery surrounding how migraines work, one reason for this gender difference is hormones.
Early childhood boys are slightly more prone to migraines than girls, but puberty drastically tips the scales. During this time, sex hormones begin to fluctuate and trigger physical changes, including the onset of menstruation. This is when girls often experience their first migraines. From puberty onwards, girls experience migraines more often than boys, and this disparity becomes increasingly apparent as people reach their mid-30s and lasting until old age“There’s chaos at both ends of a woman’s reproductive life,” MacGregor says.
In adulthood, many women with migraines report that they experience attacks associated with their menstrual cycles. A sudden drop in estradiol, a powerful form of estrogen, is thought to play a key role. A few days before menstruation, known as the delayed luteal phase, estradiol levels drop dramatically. Women who are prone to migraines tend to experience a faster rate of decline in estradiol during their period compared to women who don’t have one. While estrogen also drops around ovulation, this drop is not so fastwhich may explain why migraines are not as common during this time. The role of estrogen has also been observed in transgender women on hormone therapy, who show a similar incidence of migraine to cisgender women.
Periods of fluctuating estrogen are also linked to migraines in women. As women enter perimenopause, the transitional period leading up to menopause, their hormones become especially erratic. “Women who haven’t had menstrual migraines before are more likely to get them during perimenopause,” says MacGregor. After menopause, some people experience relief. “But it’s important to say that patterns are variable—not everyone feels better,” says Richard Lipton, a neurologist and epidemiologist at Albert Einstein College of Medicine in Recent York City.
Estrogen’s link to migraines is well-documented, but scientists don’t yet fully understand how it contributes to the onset and progression of migraines. Lipton explains that migraines are a disorder characterized by a sensitive brain. “When I say sensitive, I mean susceptible to external factors that make migraines more likely,” she says. Something like a change in hormones can trigger a response.
But estrogen doesn’t work alone. Changing estrogen levels also affect other hormones, such as serotonin, which usually protects against migraines by reducing pain sensitivity. When estrogen levels drop, as well as serotonin levelsincreasing the likelihood of a migraine. Triggers also work in tandem. When enough factors come together—such as a drop in estrogen combined with lack of sleep, irregular meals, dehydration, or stress—an attack can occur.