How Do Migraine Symptoms, Triggers Differ Based on Sex?

Female migraineurs tend to exhibit longer attack duration and greater frequency of nausea, vomiting, osmophobia, and vertigo/dizziness, compared with male migraineurs, according to a community-based study.

Although studies of migraine have consistently found the condition is more prevalent in women than men, “the differences of symptomatology, associations, and disability between men and women are poorly understood,” authors wrote.

To compare sex-specific features of migraine and demographic parameters, researchers in Turkey conducted a nationwide, population-based prevalence study that included individuals aged 18 to 65. A total of 5323 subjects were included, among whom 871 were diagnosed with definite migraine according to the International Classification of Headache Disorders-III (ICHD-III).

Through face-to-face interviews with 33 trained general physicians, investigators compiled data on migraineurs’ demographic characteristics, associated features, and triggers of migraine based on sex. Household information was determined based on an electronic questionnaire. Participants also completed the Migraine Disability Assessment (MIDAS) questionnaire.

The final cohort included 640 women and 231 men. The mean age of female migraineurs was 37.02 (standard deviation [SD] 11.4), while the mean male age was 36.74 (SD 10.8). Researchers defined the postmenopausal period as the point of time when menstruation ceased after 12 months of amenorrhea.

Data revealed:

• Stress (68.5%), wind (54.4%), hunger (54.2%), and sleeplessness (53.0%) were common trigger factors across the entire group and there was no significant difference between women and men
• Odor was reported to be a trigger in women statistically more frequently than in men, whereas excessive sleep was statistically more frequently reported as a trigger in men
• Women migraineurs were more likely to experience osmophobia (odds ratio [OR]: 1.414; 95% Cl, 1.01-1.981; P = .044, ), depression (OR: 2.564; 95% Cl, 1.696-3.875; P <.001), vertigo (OR: 0.503; 95% Cl, 0.364-0.695; P <.001), nausea (OR: 1.681; 95% CI, 1.152-2.453; P = .007) and attack duration (>24 hours) (OR: 1.759; 95% Cl, 1.206-2.566; P = .003)

According to authors, “these associated features were still significant when we compared postmenopausal women with men, except for nausea.”

Fluctuations in sex hormones, receptor binding, genetic predisposition, environmental factors, pain perception, and differences in brain function and structure may all account for the differences in symptoms between the sexes. However, researchers noted migraine frequency is lower and does not differ between sexes prior to puberty, while women experienced increased frequency during menstruation and reduced frequency after physiologic menopause.

Fluctuating levels of gonadal hormones and a complex relationship between estrogen and the condition may account for increased migraine prevalence in women.

Furthermore, “Complex genetic factors are involved in migraine in up to 60% of cases,” authors wrote. “Genetic factors, including ion-channel function, appear to set the individual threshold; internal and environmental factors including hormonal fluctuations may modulate this genetic predisposition.”

Future studies ought to explore the biologic and genetic factors associated with sex in migraine pathophysiology and symptoms. “As more is learned about the biology and genetics of migraine and about the differences between the sexes, we will be able to diagnose, treat, and estimate outcomes for both sexes more accurately,” authors concluded.

Reference

Akarsu EO, Baykan B, Erta&#351; M, et al. Sex differences of migraine: results of a nationwide home-based study in Turkey. Noro Psikiyatr Ars. 2020;57(2):126-130. doi:10.29399/npa.23240