WOMEN AND HEADACHE

Women process pain differently than men. Recent imaging studies show that in some types of experimentally induced pain, even different parts of the brain are activated in men and women. We are still discovering all the ways in the brain that this is so, but hormonal variations play a significant role in these differences.

Women perceive some, but not all, types of pain at lower thresholds than men, but this varies
depending on where they are in their hormonal cycles. Postmenopausal women perceive pain
similarly to men in experimental settings. Studies have shown that when women's estrogen levels
are high, they have a higher pain tolerance than men, and a better ability to release endorphin
and to activate mu-opioid receptors. When tested between ovulation and menstruation, when
both estrogen and progesterone levels were low, women's pain tolerance and endorphin
release were low.

Primary headache disorders affect almost one third of women in their child-bearing years.
Migraine headaches affect women three times more frequently than men. We suspect this may
be the case because of the influence of hormones on the underlying genetic tendency toward
migraine.

Recent large population-based studies have revealed that there is a higher risk of heart disease
in women who have migraine with aura. It is also known that there is a higher risk of stroke in
women who have migraine with aura.

There are other issues, however, that are worthy of discussion, and that is how hormonal cycles affect headaches themselves. Sixty per cent of women with migraine headaches report that their worst headache each month occurs at the time of their menstrual cycle. Some women only experience menstrually related migraine headaches.