Mind the Migraine

A man is talking to the viewer, but his face is partially obscured by a blur and streaks of color.

I can’t fall asleep. Can’t stay awake. I can’t close my eyes but I can’t leave them open. I can’t eat and I can’t drink, yet my stomach rumbles and my throat is dry. Can’t lie down, can’t sit up, can’t stand. The lights are off and the curtains are drawn shut. I stare into the dark expanse of my ceiling. I’m missing class; there’s so much homework I need to catch up on. It hurts.

I can’t describe the feeling of migraine in a simple and straightforward way because everyone experiences migraine differently. For Dr. Mariam Aly, Assistant Professor of Psychology at Columbia University, it’s the feeling of your head being slowly crushed by a vise. For my mother, it’s the feeling of all of your body, all of your pain, being forced in your skull. And for me, migraine is an endless series of “can’t.” I can’t do anything, except wait for it to end.

When I’m asked about my migraine, here’s how I define it: “a bunch of bad headaches, pretty often, but I’m used to it!” At least, that’s my response when I’m in conversation with acquaintances who might sympathize but not empathize, or when I want to pivot to any other topic of conversation. A more accurate (and scientific) definition would be this: migraine is a neurological disease that is characterized by intense, throbbing, and recurrent pain on one side of the head, and the term “migraine attack” refers to an individual instance of head pain [1]. Usually, migraine attacks are triggered by certain internal and external stimuli, including stress, changes in sleep, hormonal changes, weather changes, and a variety of sensory stimuli, such as flashing lights or loud sounds [2, 3, 4, 5]. An untreated migraine attack can last anywhere from four to 72 hours, and is accompanied by a slew of other nasty symptoms such as nausea, vomiting, fatigue, irritability, and sensitivity to light and sound [1, 6]. Up to 31 percent of patients with migraine also experience aura, or sensory disturbances, which serves as a sort of “warning system” prior to the migraine attack [7]. Aura typically manifests as visual or sensory symptoms, such as seeing blind spots or feeling tingling in one’s fingers, which emerge and are resolved before the onset of head pain [6].

However, there’s an aspect of migraine that seldom comes up in a short fact-filled paragraph summary: it’s a disease that predominantly affects those assigned female at birth, hereafter referred to as “female” [8]. In fact, according to the number of medical diagnoses, migraine impacts between two to three times as many females as it does those assigned male at birth, hereafter referred to as “male” [8]. With this statistic in mind, scientists have conducted research acknowledging the possibility that sex differences affect rates of migraine.

Sex Differences in Migraine

The occurrence of migraine attacks in females fluctuates throughout their lifetimes. While migraine tends to be less frequent in children than in adults, young females and young males are equally likely to develop migraine [9]. However, as children grow up, there seems to be a shift. With the onset of puberty, females begin to show an increase in migraine prevalence as compared to males, resulting again in that ratio falling between two to one and three to one [8]. These rates hold up for the majority of adulthood [8]. Yet after menopause, which generally begins in mid-life, there’s another shift: the majority of females who have migraine see an improvement in the severity and the frequency of their condition [10]. So, the rates of migraine ebb and flow throughout a female’s lifetime. Why?

One possible and prevalent theory for the sex differences in migraine is the fluctuation of estrogen levels in females due to their menstrual cycle. This explanation has been around for a while. In 1972, Australian clinician Dr. Brian Somerville studied the influence of female sex hormones on females with migraine and found a correlation between the shift in female sex hormones and the rate of migraine attacks [11]. The menstrual cycle is associated with a cyclical variation in female sex hormones such as estrogen [12]. And, while the exact rates vary from person to person, the frequency of migraine attacks tends to be higher in the two days before and three days after the onset of menstruation, when estrogen levels suddenly drop from their previously high levels [13, 14]. Over 55 percent of females have migraine attacks related to their menstrual cycle, and rates of migraine actually lower during pregnancy [15]. After menopause, however, estrogen levels stabilize, and migraine rates and symptoms improve [10]. If postmenopausal females choose to undergo hormonal replacement therapy—especially therapies that contain estrogen—their migraine tends to worsen [16]. Overall, there appears to be a strong link between sex hormones and migraine, with fluctuating levels of estrogen correlating with migraine attacks.