NEW YORK TIMES
Q. I get headaches constantly, but it seems like the men in my life get them less frequently. Are headaches more common in women? And if so, why?
It’s true: Women get more headaches than men do. In fact, when researchers asked participants in a recent national survey if they were bothered “a little,” “a lot,” “somewhere in between” or “not at all” by a headache or migraine in the past three months, women were nearly three times as likely as men to report having been bothered “a lot.”
Although there are likely many contributors, research suggests that one clear reason for the gender discrepancy is hormones.
But this doesn’t explain all headaches, and some types afflict men more than women. Here’s what we know.
Women and Migraine
One major type of headache is migraine. It is characterized by moderate to severe throbbing, usually on one side of the head, and it’s one of the most common causes of disability among women aged 15 to 49. These headaches can last from four to 72 hours.
Before puberty, boys and girls are equally likely to experience migraine headaches, said Dr. Anne MacGregor, a headache specialist at Barts and the London School of Medicine and Dentistry in Britain. But once puberty hits, migraine headaches become much more common among women and girls.
Women are two to three times as likely as men to suffer from migraine, said Dr. Jelena Pavlovic, a neurologist at the Albert Einstein College of Medicine in New York City. And this type of headache usually hits women hardest in their 30s — “an especially demanding time in life, when the consequences of days lost to debilitating pain can be tremendous,” she said.
One possible reason for this discrepancy is because women tend to report having more stress, whether from “work, social or family” obligations, said Colleen M. LaHendro, a certified nurse practitioner in neurology at Northwestern Medicine Lake Forest Hospital.
Women also tend to struggle with sleep more than men do, and fatigue can bring on these headaches.
The Role of Estrogen
Some migraine headaches are instead triggered by hormones — in particular, sudden changes in the levels of estrogen, which is mainly produced by the ovaries.
Estrogen has been shown in scientific studies to play an important role in the development of migraine headaches, which, between puberty and menopause, are much more common in women than in men.
“For more than half of women with migraine, the onset and timing of migraine is connected with the hormonal flux of their menstrual cycle,” Dr. Pavlovic said.
Many women, for instance, experience migraine headaches before and during menstruation, just after their estrogen levels drop. Dr. Pavlovic’s research has found that women who get migraine headaches tend to experience steeper estrogen drops than women who don’t.
It’s unclear exactly why estrogen fluctuations trigger migraine headaches, Dr. MacGregor said. Estrogen does important things inside the brain, so the hormonal changes must also trigger a series of events culminating in migraine.
Women may also experience changes in migraine frequency during pregnancy, when estrogen levels tend to go up and down, Ms. LaHendro said.
Migraine headaches tend to worsen during perimenopause, too, again because estrogen fluctuates, Ms. LaHendro said. But once menopause has settled in, hormone levels stabilize and many women find that their migraine headaches become less frequent.
Other Headaches and Causes
In addition to migraine headaches, women are roughly 1.5 times as likely as men to experience tension headaches, which are mild to moderate and affect both sides of the head, Ms. LaHendro said. These headaches are uncomfortable but typically aren’t debilitating, and can feel like there’s a tight band squeezing the head.
It’s unclear why tension headaches are more common in women, but stress could play a role. Some studies suggest that these headaches are more frequent in women in the days surrounding menstruation, suggesting that estrogen could again be involved. But other studies find no evidence that hormones are to blame.
On the other hand, men are more likely than women to experience cluster headaches, which are rare but extremely painful headaches that afflict only one side of the head and usually arise daily or nearly daily over the course of several weeks or months, Dr. MacGregor said.
It’s unclear why men are more likely than women to get cluster headaches, Dr. MacGregor said, but research suggests these headaches are more common in people who are heavy smokers or drinkers, and men tend to drink and smoke more heavily than women.
If you experience frequent headaches, “keep a diary and look at patterns,” Dr. MacGregor suggested. In addition to stress, sleep and hormones, consider other potential triggers such as dehydration, weather changes, medications and alcohol.
The National Headache Society suggests documenting when each headache started and ended, its intensity, its preceding symptoms, its potential triggers and any medication taken to alleviate it. A physician can then tailor treatments based on the information recorded.
The good news is that when it comes to managing headaches, Ms. LaHendro said, “there are more treatment options out there now than there have ever been before.”
