Women are 2 to 3 times more likely than men to have migraines. Decades ago, these were attributed to women’s inability to cope with stress, a sort of hysteria. Thankfully since then, medical science has established that they are biologically based. For more than half of women aged between 18 and 60, the onset and timing is connected with the hormonal flux of their menstrual cycle.
Young boys and girls are about equally likely to develop migraine. But at puberty, the prevalence in females rapidly escalates. Through adulthood, the risk increases in everyone, but it continues to climb more steeply in women. Their risk peaks at around age 35, then gradually tapers off until it declines steeply at menopause.
Hormones are only 1 factor
Although the effects of sex hormones are far reaching, they are not the only relevant factor. The cardiovascular system is also thought to play a part in migraine pathology, and here too, sex seems to matter. In a recent review article, Øie and colleagues found that that ischemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives, and smoking habits. The risk of transient ischemic attack also seems to be increased in people with migraine (Øie et al. Journal of Neurology, Neurosurgery & Psychiatry.2020). The danger can be particularly acute in women who smoke and take oral contraceptives—a combination that can increase the risk of stroke by as much as 34-fold (Chang CL, et al. BMJ. 1999).
Test your knowledge and then read on to discover two invaluable tools to help you manage their care.
Guiding the conversation
From menstruation to menopause, learn more about treatment options and how to answer questions about new symptoms and concerns as your patients enter different phases of life. The American Headache Society offers 2 downloadable PDF discussion guides “How Do I Discuss Hormones with My Migraine Patients? Common Patient Questions Answered” by Susan Hutchinson, MD, and “Contraceptive Options for Women with Migraine” by Susan Hutchinson, MD and Catherine Stika, MD. The latter includes 3 key screening questions for your patients with migraine seeking contraception options
The contents of this feature are not provided or reviewed by NPWH.