People assigned female at birth (AFAB) and those who take estrogen are at a higher risk of migraine than those assigned male at birth. People who are AFAB or take estrogen often also have more severe and long-lasting migraine attacks.

Migraine is one of the most common neurological conditions. It’s characterized by intense pain (typically on one side of the head), nausea, vomiting, sensitivity to light and sound, and visual changes. It’s thought to be a result of altered blood flow and nerve signaling in the brain.

Migraine is most prevalent in people ages 20 to 50 years old but can happen at any age. Studies suggest women are three to four times more likely than men to receive a diagnosis of migraine, and they are also more likely to have migraine attacks that last longer, are more debilitating, take longer to recover from, and recur more often.

Hormones and other factors can cause these discrepancies.

You’ll notice that the language used to share stats and other data points is pretty binary, fluctuating between the use of “male” and “female” or “men” and “women.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

The studies and surveys referenced in this article didn’t report data on or include participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

In addition to their important roles in the menstrual cycle and pregnancy, estrogen and progesterone may affect brain chemicals associated with headaches. Changes in these hormones throughout a person’s life can influence migraine frequency.

Periods and menopause

In people who menstruate, the natural drop in estrogen that occurs before their period can trigger migraine. As a person approaches menopause, hormone levels can also fluctuate, sometimes causing an increase in migraine attacks.

During menopause, when periods stop, some hormone levels decrease, and a person’s migraine episodes may happen less frequently.

Resource alert

HeadWise, a podcast produced by the National Headache Foundation, has a collection of episodes specifically related to women navigating migraine during major life transitions, including perimenopause and menopause.

Birth control and pregnancy

Hormonal birth control, such as oral contraceptive pills made of estrogen and progesterone, can either reduce or increase migraine for people with the condition who take them. In addition, women who experience migraine with aura should discuss contraceptive options with their doctor because of an increased risk of ischemic stroke.

During pregnancy, migraine is less common. It’s important to note, too, that many migraine treatments aren’t safe to take during pregnancy. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are unsafe for pregnant people.

Women who are pregnant can safely consider taking anti-nausea medication, nerve blockers, and noninvasive neuromodulators.

Estrogen replacement therapy

People who take estrogen replacement therapy during menopause may be at an increased risk of migraine. According to a 2021 systematic review, postmenopausal hormone replacement therapy was associated with worsening migraine.

Gender affirming hormone therapy

According to the American Migraine Foundation, there isn’t much data on how gender affirming hormone therapy affects migraine. But a person taking gender affirming hormone therapy may experience an increased risk of migraine similar to those taking estrogen replacement therapy.

The foundation also emphasizes the importance of speaking with your doctor about possible interactions between migraine medications and gender affirming hormone therapy.

Migraine can be triggered by many factors unrelated to hormones.

Environmental factors

Environmental factors that can trigger migraine include:

  • stress
  • bright light
  • excess noise
  • strong odors
  • changes in weather
  • changes in sleep
  • certain foods, like caffeine, alcohol, and chocolate

High stress levels are an especially strong trigger for migraine.

Occupations

Shift workers and people with jobs that require manual labor are at a higher risk of migraine than people in other occupations.

Night shift work is also associated with many other adverse health events, including obesity, hypertension, diabetes, and other conditions. Migraine is one of the consequences of night shift work that is more likely to affect women than men.

A relatively new branch of healthcare called gender medicine focuses on how factors related to sex and gender identity influence health.

Addressing sex differences in migraine

One aim of gender medicine is to increase funding, encourage inclusion efforts, and emphasize research design to gather more knowledge about determinants of women’s health.

Studying migraine from this perspective would incorporate genetic, social, and environmental data to explore migraine prevention, diagnosis, and treatment specifically in females.

Future of migraine treatment

Innovations in imaging and artificial intelligence could contribute to more precise brain diagnostics. As scientists learn more about the genetics of migraine, there may also be more targeted treatments that work based on a person’s genetic makeup.

Migraine is much more likely in people assigned female at birth and those who take estrogen than in people assigned male at birth. Experts believe this increased likelihood is primarily due to hormonal factors. Research also suggests environmental stressors are more likely to trigger migraine in women than in men.

Advances in diagnostics and treatments, as well as the advent of gender medicine, have helped experts learn more about how migraine affects females and how they can get relief.