Why migraine is so common in women
Migraine is one of the most widespread neurological conditions. Statistics show that women are affected roughly three times as often as men. While in childhood girls and boys are affected at similar rates, the ratio shifts noticeably with the onset of puberty – a first indication that female sex hormones play a central role.
Oestrogen takes centre stage here. When oestrogen levels fluctuate strongly, this can favour migraine attacks in sensitive women. A rapid drop in oestrogen in particular – as occurs shortly before menstruation – is regarded as an important trigger of what is known as hormonal migraine.
Menstrual cycle and menstrual migraine
What is menstrual migraine?
The term menstrual migraine is used when attacks regularly occur in the period from two days before to three days after the start of menstruation. Two forms are distinguished:
- Pure menstrual migraine: Attacks occur exclusively around menstruation.
- Menstrually associated migraine: Attacks occur in line with the cycle, but also at other times during the month.
These attacks are often characterised by particularly intense, long-lasting headaches that respond less well to common pain relievers than attacks outside menstruation.
Hormonal contraception and migraine
Hormonal contraceptives can influence the course of the condition – in both directions. Some women report improvement, others an increase in symptoms, especially during the pill-free interval. Important: Women with migraine with aura should only use combined hormonal contraceptives after careful medical assessment, as the risk of stroke may be increased. Individual counselling is particularly important here.
Pregnancy: Often a phase of relief
Many women with migraine experience clear improvement during pregnancy – especially in the second and third trimesters. This is due to the consistently high oestrogen level, which evens out hormonal fluctuations.
However, this does not apply to everyone affected:
- In the first trimester, attacks may initially increase as the hormonal system settles.
- In migraine with aura, the frequency more often remains unchanged.
- After childbirth – with the rapid drop in oestrogen – many women experience a return of symptoms.
During pregnancy and breastfeeding, the choice of medication is limited. Non-pharmacological measures such as relaxation techniques, regular sleep, adequate hydration and biofeedback therefore become more important. Any drug therapy during this phase of life should only be undertaken in consultation with a doctor.
The menopause: A phase of change
The perimenopause – the transitional period before the last menstrual bleed – is a particularly challenging phase for many women with migraine. Hormone levels fluctuate irregularly and markedly during this time, which can often intensify attacks.
After the menopause, when hormone levels stabilise at a lower level, many women report a clear improvement. In some of those affected, however, the migraine persists or appears more strongly for the first time.
Hormone replacement therapy: Opportunities and limits
Hormone replacement therapy used to ease menopausal symptoms can influence the course of migraine. Transdermal applications (e.g. patches, gels) generally lead to more even hormone levels than tablets and are often better tolerated in migraine. The decision for or against such a therapy should always be made individually and in discussion with a doctor.
Typical symptoms of hormonal migraine
Hormonally driven attacks often show the following features:
- pulsating, one-sided headache
- nausea, occasionally vomiting
- sensitivity to light and sound
- longer duration (often 24 to 72 hours)
- reduced response to standard pain relievers
- less frequently accompanied by aura symptoms
What can help in everyday life
Even though hormonal fluctuations cannot be entirely avoided, women with migraine can actively shape their everyday life and better recognise triggers.
Keeping a migraine diary
A headache or migraine diary is a simple but effective tool. Useful entries include:
- timing and duration of attacks
- day of the cycle
- possible triggers (sleep, stress, diet, weather)
- medications taken and their effect
Hormonal patterns can often be clearly identified this way.
Lifestyle as a foundation
For migraine in women, a stable daily routine plays an important role:
- regular sleep times
- balanced meals without long gaps
- adequate hydration
- moderate, regular exercise (e.g. endurance sports)
- stress management through yoga, meditation or progressive muscle relaxation
Therapeutic approaches
The treatment of hormonal migraine consists of several elements, depending on severity:
- Acute therapy: Pain relievers or migraine-specific medications (e.g. triptans) as prescribed by a doctor.
- Short-term prophylaxis: For predictable menstrual attacks, time-limited prevention around the menstrual period may be useful.
- Long-term prophylaxis: For frequent attacks, various medication groups are available, as are modern antibody therapies.
- Botulinum toxin type A: In chronic migraine, this therapy can contribute to symptom relief as a complement to established treatments.
- Non-pharmacological approaches: Acupuncture, biofeedback and behavioural therapy have proven to be valuable additions.
When medical assessment is advisable
A medical consultation is particularly advisable if:
- attacks become more frequent or more intense,
- pain relievers are taken on more than ten days per month,
- new neurological accompanying symptoms appear for the first time,
- migraine clearly restricts everyday life,
- uncertainties arise during pregnancy, breastfeeding or the menopause.
A well-founded diagnosis and an individually tailored treatment plan are the basis for sustainably improving quality of life.
Summary
Hormonal fluctuations significantly influence the course of migraine in many women – whether in the rhythm of the menstrual cycle, during pregnancy and breastfeeding, or during the menopause. Those who know their own patterns, maintain a stable daily routine and seek medical support have good prospects of better controlling their symptoms. The combination of information, lifestyle and individually adapted therapy forms the foundation.
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This article does not replace medical advice.