Why Do Women Get Migraines More Often Than Men?
If you’ve ever wondered why migraines seem to disproportionately affect women — striking with greater frequency, intensity, and duration — you’re not alone. Migraine is one of the most common neurological disorders worldwide, but women bear the brunt of it. Understanding why can bring clarity, reduce stigma, and point toward better management.
The Stark Numbers: Just How Big Is the Gender Gap?
Migraine isn’t rare — it affects around 15–18% of the global population. However, the disparity between sexes is striking.
Recent data shows:
- Lifetime prevalence is approximately 43% in women versus 18% in men (some studies suggest the risk is up to 3.25 times higher for women).
- Global point prevalence is around 20–22% in women compared to 9–13% in men.
- The gap emerges sharply after puberty, peaks during reproductive years (especially 20s–40s), and narrows after menopause.
Before puberty, boys and girls experience migraines at roughly similar rates. But from puberty onward, women are 2–4 times more likely to suffer attacks, which are often longer, more disabling, and accompanied by greater nausea, vomiting, and sensitivity to light/sound.
This pattern is a major clue: hormones, particularly estrogen, play a central role.
The Primary Driver: Hormonal Fluctuations
The most widely accepted explanation is the estrogen withdrawal theory. Rapid drops in estrogen — rather than absolute levels — trigger many attacks in women.
- Menstrual migraine affects 50–60% of women with migraine. Attacks typically strike in the late luteal phase (a few days before menstruation) or during the first few days of bleeding, when estrogen plummets after the luteal peak.
- Estrogen influences brain chemistry: It modulates serotonin, acts as a natural pain modulator, and affects blood vessel tone. When levels drop suddenly (below ~45–50 pg/mL in some studies), pain pathways become hypersensitive, and the trigeminovascular system (the key migraine pathway) gets activated more easily.
Life stages highlight this hormonal link
- Puberty: First attacks often coincide with menarche.
- Pregnancy: Many women improve (high, stable estrogen), though some worsen postpartum.
- Perimenopause: Erratic fluctuations can increase attacks.
- Menopause: Frequency often decreases as cycles end.
Progesterone and other hormones contribute, but estrogen fluctuations are the dominant factor.
Here are visual examples of how estrogen levels fluctuate during the menstrual cycle, showing the sharp drop that often triggers migraines:
These diagrams illustrate the typical hormonal shifts — the late-cycle estrogen drop is a common culprit for menstrual migraine.
Beyond Hormones: Biological and Brain Differences
Hormones aren’t the whole story. Women appear biologically more susceptible:
- Lower threshold for cortical spreading depression (CSD) — the wave of brain activity linked to migraine aura and pain. Studies in animal models show female brains require less stimulation to trigger CSD.
- CGRP (calcitonin gene-related peptide) — a key migraine mediator. Women often show stronger responses to CGRP, with sex differences in its expression and signaling in the trigeminovascular system. Recent research indicates dural CGRP produces more intense pain sensitisation in females.
- Genetics & epigenetics — Certain migraine-related genes express differently between sexes, and hormonal influences may activate/deactivate them variably.
- Pain processing — Women tend to have heightened sensitivity in trigeminal pathways and more reactive inflammatory responses.
These innate differences mean even non-hormonal triggers (stress, sleep loss) can hit harder in women.
Lifestyle, Environment, and Social Factors
Women often juggle more responsibilities — work, caregiving, irregular schedules — leading to common triggers like stress, poor sleep, and skipped meals. Night shifts and disrupted routines disproportionately affect women.
Women are also more likely to seek medical help and report symptoms, while men may under-report due to stigma, potentially skewing statistics slightly.
Comorbidities (anxiety, depression, other chronic pain) are more common in women with migraine, amplifying the overall burden.
Why It Matters: The Real Impact on Women's Lives
Migraine ranks as the leading cause of disability for women aged 15–49 globally[1][2][3] (measured in disability-adjusted life years). Attacks cause missed work, family time, and social activities — with women experiencing more frequent, prolonged, and disabling episodes.
The economic and personal toll is enormous, yet migraine remains under-researched in sex-specific ways.
Hope and Practical Steps Forward
The good news? Treatments are advancing rapidly.
- Hormone-aware strategies — Tracking cycles, preventive meds timed to menstruation, or stable-hormone options (e.g., continuous contraceptives, low-dose estrogen supplements in some cases).
- Modern therapies — CGRP monoclonal antibodies (e.g., erenumab, fremanezumab) work well for both sexes but hold promise for hormone-linked cases.
- Lifestyle tools — Consistent sleep, hydration, stress management, trigger tracking (apps help!), and regular exercise reduce attacks.
If migraines disrupt your life — especially if linked to your cycle — see a headache specialist. Personalised care makes a real difference.
Final Thoughts
The gender gap in migraines is real, rooted mainly in estrogen fluctuations combined with biological differences in brain excitability, pain pathways, and CGRP signaling. It’s not “just hormones” or “all in your head” — it’s a complex interplay backed by decades of research.
Knowledge empowers. Whether you’re navigating this yourself or supporting someone who is, understanding the why is the first step toward better days.
Have you noticed a cycle connection to your migraines? Share in the comments — your experiences help others feel less alone. And always consult a healthcare professional for tailored advice.
