- Migraine affects 2 to 3 times more women than men.
- A large-scale twin study suggests a link between migraine risk and hormone levels in the womb.
- Migraine treatment options have grown over the past several years.
Your risk of developing migraine as an adult may be influenced by hormone levels in the womb before you are born, according to a new study published today in the journal Pain Research.
Researchers at the University of California, San Diego (UCSD) used the world’s largest database of twins to examine the role of the prenatal environment on sex differences in migraine risk.
The study also suggests that genes that influence migraine risk may be different in men and women.
Migraine is 2 to 3 times more prevalent in women than men.
The condition is fairly common, affecting about 12 percent of the global population.
The researchers had thought that having a male co-twin would reduce the risk of migraine in females. Instead, the analysis showed an increase in risk relative to females with a female co-twin.
Data for the study came from 51,872 participants in the Swedish Twin Registry. It included information on same-sex identical and fraternal twins, as well as opposite-sex fraternal twins.
There was no information regarding age at onset of migraine, so hormonal changes such as puberty could not be assessed.
The study authors hope their research will lead to more effective and targeted treatments for migraine.
“The findings of our study are important because the more we understand the factors that contribute to migraine, and especially the differences between males and females, the more opportunity there is to improve clinical care, diagnostic abilities, and therapeutic interventions for both men and women,” said Matthew Panizzon, PhD, an assistant adjunct professor in neuropsychology at UCSD and the study’s principal investigator, in a statement.
A step forward in research
Dr. Brian Boyd is a neurologist and immediate past chief of staff at Providence St. Joseph Hospital in Orange, California.
Boyd told Healthline he found the study fascinating.
“I feel like we’re peering behind the curtain further to understand the process that leads to migraine and the experiences patients have,” said Boyd.
“I try to educate patients that migraine isn’t a condition we can cure, but a sensitized brain they’ve inherited,” he said. “As a result of this study, we know the influences of hormones begin before birth in utero. The further we understand, the more we can come up with a strategy to advance treatment.”
What it means for clinical practice
Boyd doesn’t see an immediate clinical application as a result of this study.
“I don’t anticipate a great leap forward in treatment, but 10 years from now we may look back on this study as a turning point,” he said.
Dr. Clifford Segil is a neurologist at Providence Saint John’s Health Center in Santa Monica, California.
Segil told Healthline that the male-to-female ratio of migraine outlined in the study aligns with his experience, but it doesn’t have an immediate impact on clinical practice.
“I don’t think we’ll be using hormones for migraine treatment,” said Segil, but he noted that adjustments can be made to birth control pills.
“We can try to give progestin-only birth control pills with the goal of decreasing headaches, but it doesn’t work all the time. And, progestin-only doesn’t have the efficacy of mixed estrogen and progestin and can lead to pregnancy. Changing hormones isn’t one of our most effective treatments,” Segil said.
The study might provide some relevance for genetic counseling purposes, he said.
“When the mom has migraine, it’s more likely her daughters will. If the father has migraine, it’s more likely the sons will, but there are no guarantees. What I tell people is that the apple doesn’t fall far from the tree, but everyone gets a fresh deck of cards,” Segil said.
New treatments and hope
Migraine is generally associated with severe headache, but there’s much more to it.
It’s a neurological condition that causes an array of symptoms, including nausea, dizziness, and increased sensitivity to light, sounds, and smells.
For the 3 to 5 percent of Americans who have chronic migraine — that’s 15 or more headache days a month for more than 3 months — it’s a serious quality of life issue.
“In the last few years, migraine treatment has blossomed with breakthrough medications. For people with chronic migraine, there’s a lot of motion in the pharmaceutical world. We’re having a lot of great response and it’s changing the clinical landscape,” said Segil.
He noted that some of these newer options became available around the same time as pandemic lockdowns, leading many people to put off doctor visits.
Segil urges people with migraine to contact a neurologist.
“We use neuroimaging to make sure there’s nothing more sinister going on. We can detect the type of migraine or mimics like cluster headaches. And we’re more up to date on treatment than a family practitioner,” he said.
Boyd spoke of the stigmatization some people with migraine feel.
“People tell them, ‘it’s just a headache.’ Alternatively, they think they have a condition, which feels like a failure. They can look at it in a more positive way, that it’s a sensitized brain you’re born with,” he said.
“We have so many more tools now than in the past. As a practitioner, I’ve seen people taking these new medications that are well-tolerated and more effective, and it makes a difference in their lives. It’s very gratifying to be practicing headache medicine in this era,” said Boyd.
“I applaud the vigorous and ongoing efforts of researchers that will give clinicians more tools, and that’s what it’s all about,” he said.