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Women get far more migraines than men – a neurologist explains why, and what brings relief

<p><em><a href="https://theconversation.com/profiles/danielle-wilhour-1337610">Danielle Wilhour</a>, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a></em></p> <p>A migraine is far <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/">more than just a headache</a> – it’s a debilitating disorder of the nervous system.</p> <p>People who have migraines experience severe throbbing or pulsating pain, typically on one side of the head. The pain is often accompanied by nausea, vomiting and <a href="https://theconversation.com/migraine-sufferers-have-treatment-choices-a-neurologist-explains-options-beyond-just-pain-medication-181348">extreme sensitivity to light or sound</a>. An attack may last for hours or days, and to ease the suffering, some people spend time isolated in dark, quiet rooms.</p> <p>About 800 million people worldwide <a href="https://doi.org/10.1001/jama.2021.21857">get migraine headaches</a>; in the U.S. alone, <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/">about 39 million</a>, or approximately 12% of the population, have them regularly.</p> <p>And most of these people are women. More than <a href="https://www.npr.org/sections/health-shots/2012/04/16/150525391/why-women-suffer-more-migraines-than-men">three times as many women</a> as compared to men get migraines. For women ages 18 to 49, migraine is the leading <a href="https://doi.org/10.1186/s10194-020-01208-0">cause of disability throughout the world</a>.</p> <p>What’s more, research shows that women’s migraines are <a href="https://doi.org/10.1007/s10072-020-04643-8">more frequent, more disabling and longer-lasting</a> than men’s. Women are more likely than men to <a href="https://doi.org/10.1007/s10072-015-2156-7">seek medical care and prescription drugs</a> for migraines. And women who have migraines <a href="https://doi.org/10.1186/s10194-021-01281-z">tend to have more mental health issues</a>, including anxiety and depression.</p> <p><a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29586">As a board-certified neurologist</a> who specializes in headache medicine, I find the gender differences in migraines to be fascinating. And some of the reasons why these differences exist may surprise you.</p> <figure><iframe src="https://www.youtube.com/embed/lorXYK2OtAA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">A variety of medications and therapies offer relief for migraines.</span></figcaption></figure> <h2>Migraines and hormones</h2> <p>There are several factors behind why men and women experience migraine attacks differently. These include hormones, genetics, how certain genes are activated or deactivated – an <a href="https://www.psychologytoday.com/us/basics/epigenetics">area of study called epigenetics</a> – and the environment.</p> <p>All of these factors play a role in shaping the structure, function and adaptability of the brain when it comes to migraines. The hormones <a href="https://www.healthline.com/health/womens-health/estrogen-vs-progesterone#functions">estrogen and progesterone</a>, through different mechanisms, play a role in regulating many biological functions. They affect various chemicals in the brain and may contribute to <a href="https://doi.org/10.1093/brain/aws175">functional and structural differences</a> in specific brain regions that are involved in the development of migraines. Additionally, sex hormones can <a href="https://doi.org/10.1007/s10072-020-04643-8">quickly change the size of blood vessels</a>, which can predispose people to migraine attacks.</p> <p>During childhood, both boys and girls have an <a href="https://doi.org/10.1177/0333102409355601">equal chance of experiencing migraines</a>. It’s estimated that about <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/">10% of all children will have them</a> at some point. But when girls reach puberty, their likelihood of getting migraines increases.</p> <p>That’s due to the <a href="https://doi.org/10.3389/fmolb.2018.00073">fluctuating levels of sex hormones</a>, primarily <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/estrogens-effects-on-the-female-body">estrogen</a>, associated with puberty – although other hormones, including <a href="https://my.clevelandclinic.org/health/body/24562-progesterone">progesterone</a>, may be involved too.</p> <p>Some girls have their first migraine around the time <a href="https://doi.org/10.1002/jnr.23903">of their first menstrual cycle</a>. But migraines are often most common and intense <a href="https://doi.org/10.1136%2Fbmj.39559.675891.AD">during a woman’s reproductive and child-bearing years</a>.</p> <p>Researchers estimate about 50% to 60% of women with migraines <a href="https://americanmigrainefoundation.org/resource-library/menstrual-migraine-treatment-and-prevention/">experience menstrual migraines</a>. These migraines typically occur in the days leading up to menstruation or during menstruation itself, when the <a href="https://doi.org/10.1007/s10194-012-0424-y">drop in estrogen levels can trigger migraines</a>. Menstrual migraines can be more severe and last longer than migraines at other times of the month.</p> <p>A class of medicines that came out in the 1990’s – <a href="https://www.healthline.com/health/triptan-migraine#side-effects">triptans</a> – are commonly used to treat migraines; certain triptans can be used specifically for menstrual migraines. Another category of medications, called <a href="https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids">nonsteroidal anti-inflammatory drugs</a>, have also been effective at lessening the discomfort and length of menstrual migraines. So can a variety of birth control methods, which help by keeping hormone levels steady.</p> <h2>Migraine with aura</h2> <p>But women who have <a href="https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072">migraine with aura</a>, which is a distinct type of migraine, should generally avoid using estrogen containing hormonal contraceptives. The combination can increase the risk of stroke because estrogen can promote <a href="https://doi.org/10.1016/j.thromres.2020.05.008">the risk of blood clot formation</a>. Birth control options for women with auras include progesterone-only birth control pills, the Depo-Provera shot, and intrauterine devices.</p> <p>Auras affect about 20% of the people who have migraines. Typically, prior to the migraine, the person most commonly begins to see dark spots and zigzag lines. Less often, about 10% of the time, an inability to speak clearly, or tingling or weakness on one side of the body, also occurs. These symptoms slowly build up, generally last less than an hour before disappearing, and are commonly followed by head pain.</p> <p>Although these symptoms resemble what happens during a stroke, an aura tends to occur slowly, over minutes – while strokes usually happen instantaneously.</p> <p>That said, it may be difficult and dangerous for a nonmedical person to try to discern the difference between the two conditions, particularly in the midst of an attack, and determine whether it’s migraine with aura or a stroke. If there is any uncertainty as to what’s wrong, a call to 911 is most prudent.</p> <figure><iframe src="https://www.youtube.com/embed/Tn91p-PY2h8?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">If you’re a woman and your migraines happen at the same time every month, it might be menstrual migraines.</span></figcaption></figure> <h2>Migraines during pregnancy, menopause</h2> <p>For women who are pregnant, migraines can be particularly <a href="https://www.stanfordchildrens.org/en/topic/default?id=headaches-in-early-pregnancy-134-3">debilitating during the first trimester</a>, a time when morning sickness is common, making it difficult to eat, sleep or hydrate. Even worse, missing or skipping any of these things can make migraines more likely.</p> <p>The good news is that migraines generally tend to lessen in severity and frequency throughout pregnancy. For some women, they disappear, especially as the pregnancy progresses. But then, for those who experienced them during pregnancy, migraines tend <a href="https://americanmigrainefoundation.org/resource-library/postpartum-headache/">to increase after delivery</a>.</p> <p>This can be due to the decreasing hormone levels, as well as sleep deprivation, stress, dehydration and other environmental factors related to caring for an infant.</p> <p>Migraine attacks can also increase during <a href="https://my.clevelandclinic.org/health/diseases/21608-perimenopause">perimenopause</a>, a woman’s transitional phase to menopause. Again, fluctuating hormone levels, <a href="https://www.verywellhealth.com/perimenopause-and-migraines-4009311">particularly estrogen, trigger them</a>, along with the chronic pain, depression and sleep disturbances that can occur during this time.</p> <p>But as menopause progresses, migraines generally decline. In some cases, they completely go away. In the meantime, there are treatments that can help lessen both the frequency and severity of migraines throughout menopause, including <a href="https://www.webmd.com/menopause/menopause-hormone-therapy">hormone replacement therapy</a>. Hormone replacement therapy contains female hormones and is used to replace those that your body makes less of leading up to or after menopause.</p> <h2>Men’s migraines</h2> <p>The frequency and severity of migraines slightly increase for <a href="https://doi.org/10.1177/0333102409355601">men in their early 20s</a>. They tend to slow down, peak again around age 50, then slow down or stop altogether. Why this happens is not well understood, although a combination of genetic factors, environmental influences and lifestyle choices may contribute to the rise.</p> <p>Medical researchers still have more to learn about why women and men get migraines. Bridging the gender gap in migraine research not only empowers women, but it also advances understanding of the condition as a whole and creates a future where migraines are better managed.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207606/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/danielle-wilhour-1337610">Danielle Wilhour</a>, Assistant Professor of Neurology, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/women-get-far-more-migraines-than-men-a-neurologist-explains-why-and-what-brings-relief-207606">original article</a>.</em></p>

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13 things neurologists do to help prevent Alzheimer’s disease

<p><strong>Understand Alzheimer's disease</strong></p> <p>Alzheimer’s disease is the leading cause of dementia. But all dementia is not Alzheimer’s, says Dr David Knopman, a neurologist at the Mayo Clinic in Minnesota. Dementia is a general term used to describe a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. </p> <p>Alzheimer’s is a physical disease that targets the brain, causing problems with memory, thinking and behaviour. It is also age-related (symptoms usually start at age 65) and progressive, as symptoms usually  worsen over time. Research shows that plaques and tangles two proteins that build up and block connections between nerve cells and eventually kill nerve cells in the brain, cause Alzheimer’s symptoms.</p> <p><strong>Get enough sleep</strong></p> <p>When you toss and turn all night, levels of brain-damaging proteins in the cerebrospinal fluid can rise: A 2017 study in Brain suggests that those with chronic sleep problems during middle age may increase their risk of Alzheimer’s later in life. </p> <p>“You have to commit to the importance of sleep,” says neurologist Dr Gayatri Devi. “I prioritise sleep as one of the most important activities I do – I will leave a party early in order to get a good night’s sleep.”</p> <p><strong>Stay socially active</strong></p> <p>Say yes to those social invitations! A 2019 study published in PLOS Medicine found that social activity with friends in your 60s could lower your risk of dementia by 12%. “There is something intrinsically valuable about social engagement,” says Dr Knopman. </p> <p>“It makes sense that those who are more engaged, especially socially, will think more positively and have a better outlook on life.”</p> <p><strong>Keep learning</strong></p> <p>People with advanced degrees have a lower risk of Alzheimer’s, according to 2017 research published in the BMJ. Education seems to build a ‘cognitive reserve’, which enables the brain to better resist neurological damage. </p> <p>“Higher education has a powerful effect,” says Dr Knopman. It’s never too late, check out the continuing education courses offered online or near you.</p> <p><strong>Learn a second language</strong></p> <p>Speaking more than one language can protect against Alzheimer’s disease and other types of dementia, according to 2017 research published in Clinical Interventions in Aging. </p> <p>While no one is sure why a second language helps so much, Dr Knopman theorises that the effort to communicate bilingually is like a workout for the brain, helping preserve grey matter and neurons.</p> <p><strong>Do it yourself</strong></p> <p>Challenging your brain in new ways can enhance memory as you age. Dr Devi has her own take on this: “If there is a problem with the phone or the plumbing, I will try to fix it,” she says. </p> <p>“If I try to figure out how to fix this on my own, it is good for my brain.” Right now she’s designing and building a window seat. “It is a way to keep different parts of my brain thriving.”</p> <p><strong>Stay active</strong></p> <p>Exercise is crucial to your wellness and your brain. Research published in Cureus in 2020, found that people who exercise regularly can slow cognitive decline. According to the Alzheimer’s Society, the combined results of 11 studies indicate that regular exercise can reduce the risk of developing dementia by about 30%; it drops the risk of Alzheimer’s by 45%. </p> <p>“When you are physically active, you burn more calories and you’re less likely to be obese,” explains Dr Knopman. “You’ll have better cardiovascular health because you are pushing your heart rate.”</p> <p><strong>Take care of your heart</strong></p> <p>“What is good for the heart is good for the brain,” says Dr Devi. Conditions such as high blood pressure, diabetes and high cholesterol, which increase the risk of cardiovascular disease, may also increase the risk of developing Alzheimer’s, and a 2017 study in JAMA found that middle-aged people with risk factors for heart attacks and stroke are also more likely to develop changes in the brain that can lead to the disease. </p> <p>“Anything that keeps the heart healthy is directly related to brain health,” Dr Devi says. It also reduces the risk of stroke, which can cause its own kind of dementia – vascular dementia.</p> <p><strong>Lower your stress levels</strong></p> <p>Persistent stress can take a toll on the brain, and 2018 research published in Neurobiology of Stress indicates that chronic stress can accelerate Alzheimer’s disease. When you’re stressed, your body releases cortisol, a hormone linked to memory trouble. </p> <p>In addition, experts have found that stress can lead to conditions such as depression and anxiety, which also increases the risk for dementia, according to research in Current Opinion in Psychiatry. “Eliminating stress helps reduce the amount of cortisol and optimises glucose utilisation, which your brain needs for food,” says Dr Devi.</p> <p><strong>Try the MIND diet</strong></p> <p>A combination of the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet, the MIND diet is designed specifically for brain health. (MIND is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay.) The diet is pretty pleasant: you eat at least three servings of whole grains a day, two portions of vegetables (one of which must be a leafy green), snack on nuts, eat lean proteins like chicken and fish, berries, and have a glass of wine a day. </p> <p>According to research in Alzheimer’s &amp; Dementia, those who adhered to the diet rigorously were able to lower their risk of cognitive decline later in life. You can’t trust all diets, warns Dr Knopman, but he likes this approach: “I tell my patients that if you follow a reasonable diet with lots of fresh fruits and vegetable that balances different food groups, and avoid obesity, you will be okay.”</p> <p><strong>Get your snoring checked out</strong></p> <p>Another way to wreck your sleep without realising it is with sleep apnea. According to the US National Institutes of Health, sleep apnoea occurs when a person’s upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. Many factors – from obesity to large tonsils to neuromuscular disorders – can cause sleep apnoea. </p> <p>Sleep apnoea not only prevents restful sleep, but untreated it can increase the risk of developing certain health conditions. “If left untreated, sleep apnoea has significant cardiovascular consequences and consequences of mental function,” says Dr Knopman.</p> <p><strong>Protect your head</strong></p> <p>According to the Alzheimer’s Association, there is a strong link between serious head trauma and developing Alzheimer’s later in life, especially if the injury involves loss of consciousness. A 2017 review of research in PLOS One suggests head injuries that require medical attention may increase the risk of dementia and Alzheimer’s disease. </p> <p>Wear a helmet while cycling, make your home fall-proof, and always use a seat belt to help protect your noggin.</p> <p><strong>Drink a cup of tea</strong></p> <p>Green tea has loads of health benefits – including some for your brain. A 2019 systematic review in Nutrients found that green tea might reduce the risk of dementia. </p> <p>And research in the Journal of the American Chemical Society found that it’s a compound in the beverage that can disrupt the formation of toxic plaques that contribute to Alzheimer’s disease.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/conditions/13-things-neurologists-do-to-help-prevent-alzheimers-disease?pages=1" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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