Why Women Get Migraines More Than Men

Migraine attacks are present no common headache. They can cause severe pain and illness, lasting hours or even days, making it impossible to do anything but rest in a dark, quiet room. And for millions of women, these debilitating attacks are not just occasional but a constant ordeal.

Women suffer from migraines three times more often than men, with episodes lasting longer and more intense. “It’s a lot more common than most people think,” says Anne MacGregor, head and women’s health specialist. Despite various treatments, headache is still the leading cause of disability-adjusted life years (DALYs)—a measure of disease burden caused by time lost due to illness—in women between 15 and 49 years of age. Although it is still a mystery how migraines work, one reason for these gender differences is hormones.

During childhood, boys are more prone to migraines than girls, but puberty tips the balance in a surprising way. During this time, sex hormones begin to fluctuate and cause physical changes including the onset of menstruation. This is often when girls experience their first migraine. From puberty onwards, girls experience migraines at a higher rate than boys, and this difference becomes more pronounced as people reach their mid-thirties and persist until death. “There is confusion at the two ends of a woman’s reproductive years,” MacGregor said.

In adulthood, many women who suffer from migraines report that they experience attacks that coincide with their menstrual cycle. A sudden drop in estradiol—a stronger form of estrogen—is thought to play an important role. A few days before menstruation, known as the late luteal phase, estradiol levels drop. Women who are prone to migraines tend to experience a faster rate of drop in estradiol during menstruation compared to women who do not. While estrogen declines around ovulation, again, the decline is not as rapid, which may explain why migraines are less common around this time. The role of estrogen has also been observed in transgender women on hormone therapy, who show similar migraine frequency to cisgender women.

Fluctuating estrogen levels are also linked to migraines in women. As women reach menopause, the period of change that leads to menopause, hormones fluctuate. “Those women who did not have menstrual migraine before are more likely to experience it during menopause,” said MacGregor. After menopause, some experience relief. “But it’s important to say that patterns change—not everyone gets better,” said Richard Lipton, a neurologist and epidemiologist at the Albert Einstein College of Medicine in New York.

Estrogen’s link to migraines is well documented, but researchers don’t fully understand how it contributes to the onset and progression of migraines. Lipton explains that migraine is a disease characterized by a sensitive brain. He says: “When I say I am sensitive, I mean that I am vulnerable to external factors that make it easy to be disappointed. Something like hormonal changes can cause a reaction.

But estrogen doesn’t do it alone. Changing estrogen levels also affects other hormones such as serotonin, which often prevent migraines by reducing pain sensitivity. When estrogen levels drop, so do serotonin levels, increasing the likelihood of migraines. Triggers also work in parallel. When enough factors come together—such as low estrogen, combined with poor sleep, irregular diet, dehydration, or stress—an attack may occur.