Migraine is one of the most common chronic conditions in the world. And yet, it has a surprisingly specific target: women ages 20 to 50.
After puberty, migraine is about three to four times more prevalent in women than in men. Women also report having longer, more disabling attacks, as well as a lengthier recovery process than men.
“It’s very clear that hormone fluctuations are frequently a trigger of migraine in women, and it seems to be particularly connected with drops in estrogen levels,” says Timothy Collins, MD, chief of the headache and pain division of the neurology department at Duke University School of Medicine in Durham, North Carolina.
These hormone shifts can also cause more severe migraine attacks at certain times of a woman’s life. But there are ways to manage the pain and help keep attacks at bay — no matter how old you are or how long you’ve had the condition — and it all starts with awareness about the impact of migraine in women.
1. Migraine Attacks Can Strike Around Menstruation
Sometimes called “period headaches,” catamenial or menstrual migraine attacks typically strike up to two days before or during menstruation. These attacks are caused by the natural drop in estrogen levels that occurs just before the arrival of your period, says Dr. Collins.
If migraine attacks only occur during menstruation, your doctor may recommend taking a fast-acting triptan (a type of prescription medication for migraine). “Because these headaches are limited to a short time period, you may not need to be on a preventive or long-term treatment,” says Medhat Mikhael, MD, a pain management specialist and medical director of the nonoperative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. But if you also experience migraine attacks during other times of the month, you may benefit from a preventive migraine medication.
2. Your Medication Regimen May Have to Change if You’re Trying to Get Pregnant
“If there’s any chance you’re going to get pregnant or have children within the next 6 to 12 months, speak up, because that influences our choices on preventive medication,” says Collins. Why? Some medications can take months before they fully clear from your system once you stop taking them.
3. Migraine Symptoms Can Improve During Pregnancy
“Some people say [pregnancy] was the best time for them, since they didn’t get any migraine attacks,” says Dr. Mikhael.
4. After Childbirth, Migraine Can Return
After delivery, though, there’s a good chance you can resume your normal medication regimen. There’s good evidence that some preventive migraine medications are safe to take after pregnancy, even if you’re nursing, says Collins.
5. You May Be Prone to Migraine Attacks During Perimenopause
During perimenopause, or the years leading up to menopause, estrogen levels can fluctuate wildly, causing an increase in the number and severity of migraine attacks. “This period is usually the worst phase, because there’s a lot of hormonal changes and fluctuations,” says Mikhael.
Treatments that stabilize estrogen levels, such as birth control pills, estrogen patches, and other hormone therapies, might help lessen migraine. Preventive medications are another option to help keep attacks at bay.
6. After Menopause, Migraine Often Improves
7. Treatment Can Help, No Matter Your Stage of Life
Treatment and care for women who have migraine is getting better, thanks in part to the development of new medications that can help control the condition. “Migraine should never be dismissed,” says Collins. “It’s not just a headache. It’s an ongoing disease.”
If attacks are frequent or getting in the way of your daily life, speak up. “And talk to someone else if you feel like your doctor isn’t listening to your complaints or your treatment isn’t effective,” he says. “There are so many options for [migraine attack] prevention. Don’t give up after the first treatment you try.”
The Takeaway
- Migraine is much more prevalent in women than men, partly due to fluctuating estrogen levels, which can trigger attacks.
- Migraine can worsen around the time of menstruation and in perimenopause, but for many women, it subsides during pregnancy and postmenopause.
- Preventive medications and lifestyle habits, such as regular sleep and good hydration, can help prevent migraine attacks in women. Some doctors may also recommend hormonal birth control to manage migraine.
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