Anyone who has suffered from migraines or cluster headaches knows the life-interrupting pain that accompanies them. What makes this already awful experience worse is knowing that gender plays a role in their development, diagnosis, and treatment. As someone who has suffered from migraines with auras for many years, this topic is very close to my heart. I’ve experienced the scare of one doctor diagnosing a medication that the next doctor said made me more susceptible to strokes. I’ve experienced the misery of missing university to spend the day in my dark, cold bathroom. So, let’s explore how gender affects migraines, and how we can move towards more equitable headache cures.
First, a note on language. As migraines are medicalised, most studies are focused on the biological categories of ‘male’ and ‘female’, which are defined by reproductive organs. The studies do explore the presence of certain hormones such as oestrogen and testosterone, limiting their applicability to intersex and transgender people. However, I will also be exploring some of the social factors that influence migraines, which can be applied to all those who identify as women. Similarly, this article discusses the fact that women’s pain is not always taken seriously by doctors, a notion that definitely affects transgender, agender, and gender non-binary people. When talking about the biological binary understanding of ‘female’ I will use AFAB (assigned woman at birth) and AMAB (assigned male at birth), and when talking about the socialised gender ‘woman’ I will use the aforementioned.
AFABs are three to four times more likely to suffer from migraines than AMABs. When puberty hits, AFABs are far more likely to start experiencing migraines, and the attacks are usually more severe and have a longer recovery period. Despite AFAB’s lives being disrupted so fundamentally by this condition, the sex differences are not fully understood. Scientists believe the difference comes from the larger presence of oestrogen and progesterone, but massive knowledge gaps remain. AFABs can also experience migraines triggered by their menstrual cycles, either before or after bleeding starts. Similarly, AFABs often experience an increase in migraines in the perimenopausal phase. Although there are ways to alleviate the suffering, there is no current cure for migraines. Some treatments include continuous hormonal contraception, triptans, and, according to the NHS website, lying in a dark room for a few hours. This hormonal understanding of migraines is particularly interesting in the case of transgender people, as sometimes transitioning can increase or decrease the likelihood of migraines. This is similar to those who have hysterectomies and oophorectomies.
There are also social factors that affect migraine prevalence. The fact that those who are most likely to experience these headaches are women in their thirties who have experienced pregnancy and childbirth at least once whilst trying to maintain a career speaks for itself. Whilst stress can definitely trigger migraines, it is not good enough to leave the diagnostics there. Women in pain are often not taken seriously by doctors. Many women migraine sufferers have been told they are ‘overstressed’ or ‘overreacting’. This is partly because of the patriarchal desire for ‘diagnostic superiority’ that argues you cannot experience a migraine without also experiencing aura. This is scientifically inaccurate and leads to underdiagnosis and mistreatment. Triggers are varied among sufferers and are exacerbated in those already sensitive to sensory overload. So, social factors are important and relevant to the discussion, and telling women sufferers to ‘relax with a glass of wine’ is not the answer.
It is also important to note that whilst migraines are experienced equally across races and ethnicities, treatment is more freely offered to white people. According to the American Migraine Foundation, BIPOC and other underrepresented groups are less likely to seek medical advice for extreme headaches. There are many reasons for this, mainly discrimination and lack of access to healthcare especially in the United States where this study took place. It is well documented that the pain of Black people, Black women in particular, is systematically ignored. This discrimination exists at every level of the healthcare system.
Migraines can be life-threatening if treated incorrectly. Those who suffer from migraines with auras are at greater risk of ischemic strokes, especially if they use oral contraception. “But didn’t you say earlier that doctors prescribe continuous hormonal contraceptives as a treatment for migraines?” Yes. Yes, I did. They are also majorly disruptive to day-to-day life: for every 1 million reported migraines, an estimated 400,000 days of work and school are lost. There is very little support at school or work for those who suffer, despite the incapacitation they cause. It is essential that we start to close the knowledge gaps that exist around migraines to help all sufferers and to start closing the gender gap in healthcare.