On an overall life-time basis, women are more apt than men to suffer from headaches. However this varies with type of headache as well as with age. More women than men suffer from migraine and tension-type headaches (TTH), while men predominate in cluster headache pain, the least common type. It is not clear why more women than men should be susceptible to tension headaches. The only other demographic link to tension headaches is educational: A study of 13,000 individuals by Johns Hopkins University School of Public Health, published in the Journal of the American Medical Association, showed greater occurrence of tension headaches in more educated individuals – in addition to confirming the known preponderance in women in general. Those who went to graduate school had the highest rates of TTH, almost 50% in both genders.
Prior to puberty, boys and girls are equally affected by migraine headaches, with boys in fact having on average a younger onset. After puberty more women than men are affected by migraines, averaging an 18% occurrence rate compared to 6% in men. The rate can be as high as 24% for women in their peak reproductive years of 18 – 32. Said another way, seventy percent of migraine sufferers (migraineurs) are women. Of those, sixty to seventy percent say that their headaches are linked to their menstrual cycle. And indeed, migraine frequency in women decreases after menopause.
All of these statistics point to a hormonal effect on serious headaches in women. In particular it is sudden changes in estrogen levels that usually precipitate headaches. Thus the common occurrence of pre-menstrual migraine, as estrogen and progesterone levels plummets to their lowest at this time. Also, as estrogen levels stabilize during pregnancy, migraine attacks often disappear – in two-thirds of pregnant women in one study. However, there are also some women who report migraine onset in early pregnancy, with it often subsiding in later trimesters. This of course overlaps with the time of greatest likelihood of ‘morning sickness,’ but the significance of this association is not known.
The association of migraine with changing hormone levels has direct relevance to women practicing hormonally-based birth control – i.e., those taking “the pill” – as well as those receiving post-menopausal hormone replacement therapy (HRT). Both of these groups experience frequent onset of migraine headaches, and headache was first common side effect seen in the mid-1960’s when birth control pills appeared. Later versions of contraceptive pills reduced their levels of estrogen and/or used progesterone, leading to a lower occurrence rate of migraine than with earlier formulations of the pill. However there still remains the possibility that some women will experience headaches with either starting or stopping of contraceptive medicines. In these cases, a monthly regimen with fewer placebo (inactive) days may help, as well as wearing an estrogen skin patch during the inactive week of the contraceptive cycle. All-progestin containing pills may be attempted – or completely non-hormonal contraceptive means can be considered.
If you are suffering from one or more of these conditions, and you would like us to help, please call our office today at 713.467.4082.