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What women need to know about migraines

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What’s the connection between hormones and migraine headaches?

As those with migraines know all too well, the throbbing pain associated with these headaches can be severe and debilitating. And all is not equal between the sexes when it comes to these crippling attacks. Research shows that migraines are three times more common in women than in men.

While the cause of this gender gap is not known for certain, experts say hormones play a big role. Stephanie Faubion, M.D. , director of Mayo Clinic’s Office of Women’s Health and lead author of a recent overview of migraine in women published in Mayo Clinic Proceedings, explains why women’s risks for migraine changes over their lifetimes and the potential role of hormones for treatment.

What’s the difference between a headache and a migraine?

Migraine headaches are characterized by throbbing, pulsating pain — often on one side of the head. It can be moderate to severe and last four to 72 hours. These attacks often are accompanied by nausea, vomiting and extreme sensitivity to light and sound. In some cases, people experience aura before or during a migraine. These are symptoms of the nervous system and can include flashes of light, blind spots or tingling on one side of the face or on the arm or leg.

Watch: Dr. Faubion discusses what women need to know about migraines.

Are there certain times during a woman’s life when she has a higher risk of developing migraines?

The clear answer is “yes,” according to Dr. Faubion.

“We don’t know why women are more likely than men to experience migraine headaches, but we know that women are more vulnerable in certain times of their lives when hormone levels vary,” Dr. Faubion says.

The likelihood of migraines increases when girls begin menstruating. Women are also at heightened risk of developing migraines after giving birth and during perimenopause — the time when a woman’s ovaries start to produce less estrogen. By the time they reach menopause, roughly 40 percent of women have experienced migraine.

What role do hormones play in causing migraines in women?

A sudden drop in the female hormone estrogen can trigger migraines in women. In fact, up to 70 percent of women with migraines report a connection between their attacks and their periods. Menstrual-related migraines are not typically associated with aura.

“The classic timeframe for a menstrual migraine is one to two days prior to the start of a woman’s period and lasts one to two days into the menstrual cycle,” Dr. Faubion says.

During pregnancy when estrogen levels rise, most women report improvement in their migraines. But after giving birth, estrogen levels drop precipitously, and women can experience severe migraines. During perimenopause, women can experience migraines more frequently due to sudden drops in estrogen levels.

“It can be rocky during the perimenopausal timeframe, but, generally speaking, migraine headaches tend to be less frequent after menopause,” Dr. Faubion says.

What treatment options are available for women with migraines?

If standard migraine treatments aren’t working, hormonal contraceptive methods, such as birth control pills, patches and vaginal rings may help. These hormonal treatments prevent a sudden drop in estrogen when taken in a continuous fashion.

“If we can avoid that drop in estrogen, then we can often prevent migraine attacks,” Dr. Faubion says.

She says for patients with hormone-related migraines who are otherwise healthy and able to take birth control pills, she routinely prescribes a low-dose pill until they reach menopause.

While hormonal therapy isn’t an option for everyone, it has the potential to help put an end to menstrual-related migraines for some women.

“When you are losing a week out of your life every month because of migraine headaches, that is not a small thing,” Dr. Faubion says.

This article was adapted from Mayo Clinic News Network.

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• 05 July 2024

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For one billion people worldwide, the symptoms can be debilitating: throbbing head pain, nausea, blurred vision and fatigue that can last for days. But how brain activity triggers these severest of headaches — migraines — has long puzzled scientists.

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Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren't the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.

Headaches are generally classified by cause:

Primary headaches

A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn't a symptom of an underlying disease.

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

The most common primary headaches are:

• Cluster headache
• Migraine with aura
• Tension headache
• Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania

A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.

Although generally considered primary, each could be a symptom of an underlying disease. They include:

• Chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)
• Cough headaches
• Exercise headaches
• Sex headaches

Some primary headaches can be triggered by lifestyle factors, including:

• Alcohol, particularly red wine
• Certain foods, such as processed meats that contain nitrates
• Changes in sleep or lack of sleep
• Poor posture
• Skipped meals

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.

Possible causes of secondary headaches include:

• Acute sinusitis
• Arterial tears (carotid or vertebral dissections)
• Blood clot (venous thrombosis) within the brain — separate from stroke
• Brain aneurysm
• Brain AVM (arteriovenous malformation)
• Brain tumor
• Carbon monoxide poisoning
• Chiari malformation (structural problem at the base of your skull)
• Coronavirus disease 2019 (COVID-19)
• Dehydration (when the body doesn't have enough water and other fluids to work as it should)
• Dental problems
• Ear infection (middle ear)
• Encephalitis (brain inflammation)
• Giant cell arteritis (inflammation of the lining of the arteries)
• Glaucoma (acute angle closure glaucoma)
• High blood pressure (hypertension)
• Influenza (flu) and other febrile (fever) illnesses
• Intracranial hematoma
• Medications to treat other disorders
• Monosodium glutamate (MSG)
• Overuse of pain medication
• Panic attacks and panic disorder
• Persistent post-concussive symptoms (Post-concussion syndrome)
• Pressure from tight headgear, such as a helmet or goggles
• Pseudotumor cerebri (idiopathic intracranial hypertension)
• Toxoplasmosis
• Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

• Ice cream headaches (commonly called brain freeze)
• Medication overuse headaches (caused by overuse of pain medication)
• Sinus headaches (caused by inflammation and congestion in sinus cavities)
• Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)
• Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes)

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

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When Should You Worry About a Headache?

Types and causes.

• Serious Symptoms

Frequently Asked Questions

• Next in Headache Guide What Is a Headache?

Most headaches are not a cause for alarm or unnecessary worry. That said, a severe headache, or a headache associated with specific symptoms like a high fever or a new neurologic deficit (alteration of brain, nerve, or muscle function), may be a sign of a potentially life-threatening condition like a brain infection or stroke.

Other scenarios like a new headache in pregnancy or a headache changing in pattern also warrant further investigation.

This article explains some of the key headache symptoms that should alert you to seek medical attention. It also provides an overview of headache types and basic treatment and preventive strategies.

Illustration by Joules Garcia for Verywell Health

Most headaches are primary headaches , meaning they exist on their own and are not caused by an underlying health problem.

The most common types of primary headaches are:

• Migraine is an intense, throbbing headache often associated with nausea, vomiting, and light/noise sensitivity that can last up to 72 hours .
• Tension-type headaches cause a dull, "band-like" tightening or pressure sensation on both sides of the head and can last anywhere from 30 minutes to seven days.
• Cluster headaches cause an excruciating stabbing or burning pain in or around the eye or temple on one side and last between 15 and 180 minutes. Associated symptoms include eye redness and tearing, stuffy nose, and sweating.

It's likely that most primary headaches arise from a complex interplay of factors (e.g., genetics, structural brain changes, and/or sensitization of pain pathways). Environmental factors, such as stress, lack of sleep, weather changes, alcohol intake, and menstruation, also appear to contribute to headache development.

Unlike primary headaches, secondary headaches arise from an underlying condition or situation (e.g., illness, pregnancy, or medication). Most secondary headaches are not serious or dangerous, except in rare instances.

Examples of less serious (typically) secondary headaches include:

• Sinus headaches stem from sinus inflammation/infection and are usually associated with thick nasal green or yellow discharge.
• Post-infectious headaches are usually caused by viruses like the common cold , flu , or COVID-19 .
• Cold-stimulus headaches, also known as ice-cream or brain freeze headaches , occur after eating cold foods or exposing the unprotected head to low temperatures.
• Cervicogenic headaches are caused by a bone, joint, or soft tissue problem in the neck.

Serious Headaches and Symptoms

While not a complete list, here are examples of possible serious causes and symptoms of a secondary headache. These are conditions for which you should seek out a medical opinion urgently or get emergency medical help.

A stroke develops when blood flow to the brain is cut off. There are two types of strokes— ischemic and hemorrhagic —and both may cause a headache:

• Ischemic stroke   occurs when an artery that supplies blood to the brain becomes clogged.
• Hemorrhagic stroke  occurs when an artery in the brain breaks open and starts bleeding within or around the brain.

A headache from an ischemic stroke is more common in younger patients, those with migraine, and those who have had a larger stroke. The headache classically resembles a tension headache and develops around the same time as the neurological deficit (e.g., weakness or numbness on one side of the body or slurred speech).

A common example of a hemorrhagic stroke is a subarachnoid hemorrhage . This type of brain bleed classically causes a thunderclap headache —an explosive headache that comes on suddenly and becomes severely painful within seconds or less than one minute.

Besides a subarachnoid hemorrhage, a thunderclap headache may also occur with other serious health conditions, including:

• Reversible cerebral vasoconstriction syndrome (blood vessels in the brain suddenly narrow)
• Cervical artery dissection (formation of a tear in the wall of the carotid or vertebral artery in the neck)
• Pituitary apoplexy (bleeding into or loss of blood supply to the pituitary gland, located in the brain)

Brain Infection

The combination of a headache and fever may indicate a type of brain infection such as:

• Meningitis : Inflammation of the meninges, the protective coverings around the brain and spinal cord.
• Encephalitis : Inflammation of the brain tissues.
• Brain abscess : When a collection of infected fluid builds up in the brain.

Besides a fever and headache, other potential symptoms of a brain infection include:

• Neck stiffness
• Altered consciousness or loss of consciousness

Brain Tumor

A brain tumor is a collection of abnormal cells that grows in the brain. While headache is a common (and may be the only or worst) symptom of a brain tumor, keep in mind that brain tumors are overall rare occurrences.

The headache from a brain tumor may feel like a migraine or tension-type headache and tends to worsen with coughing or bending over .

A headache from a brain tumor may also be accompanied by nausea and vomiting. This tends to result from increased intracranial pressure (ICP) or hydrocephalus—when there is too much cerebrospinal fluid (CSF) in the brain.

Brain Injury

A headache may occur within days after a traumatic brain injury , such as a concussion . Post-traumatic headaches often feel like a dull, aching sensation felt all over and may be accompanied by dizziness, fatigue, problems with concentration and memory, and irritability.

Post-traumatic headaches due to concussion are generally not attributable to a structural cause, but occasionally can be caused by abnormal blood collections within the skull caused by head or neck trauma.

When to Seek Medical Attention

Below are worrisome signs that your headache may be stemming from a serious underlying condition.

Seek medical attention right away if:

• Your headache is severe and starts suddenly.
• Your headache occurs with fever, stiff neck, seizures, fainting, confusion, or neurological symptoms like weakness or numbness.
• Your headache is accompanied by a painful red eye or tenderness near the temples.
• Your headache pattern is changing (e.g., becoming more frequent) or interfering with daily activities.
• Your headache is triggered by sneezing, coughing, or exercising.
• Your headache occurs after a blow or injury to the head.
• You are experiencing a new headache or a change in headache during pregnancy  or immediately after giving birth.
• You have a headache and a history of cancer or a weakened immune system (e.g., HIV/AIDS ).
• You are age 65 and over and are experiencing a new type of headache.
• Your headaches are accompanied by painkiller overuse (indicative of possible medication overuse headache ).

The treatment of headaches depend on the type and severity.

Primary Headaches

Most primary headaches can be treated with a combination of medication and home remedies.

For example, tension-type headaches can often be treated with over-the-counter (OTC) pain relievers like Tylenol (acetaminophen) or the nonsteroidal anti-inflammatory drug (NSAID) Advil (ibuprofen). Soaking in a warm bath or drinking a caffeinated beverage may also be helpful.

Likewise, mild to moderate migraines are often treated with NSAIDs. A class of oral drugs known as  triptans —for example, Imitrex (sumatriptan)—is used to treat moderate to severe migraines. For those who cannot tolerate triptans, Reyvow (lasmiditan) may be tried.

Napping in a quiet, dark room and applying a cold compress to the forehead can also be effective in helping to soothe a migraine.

For cluster headaches, oxygen therapy (inhaling high flow oxygen), Imitrex (sumatriptan) injection, and Zomig (zolmitriptan) nasal spray may be used as an acute treatment.

Talk With Your Doctor

Before taking any medication for your headache, talk with your healthcare professional. If you are on a blood thinner or have kidney, liver, or ulcer disease, your doctor will want you to avoid certain OTC drugs or take a lower dose.

Secondary Headaches

The treatment of secondary headaches requires addressing the underlying condition.

For example, a sinus headache may be treated with OTC pain relievers like Tylenol or ibuprofen. Your doctor may also recommend saline nasal sprays and/or a  corticosteroid nasal spray to reduce sinus inflammation. In rare cases of bacterial sinusitis, an antibiotic may be prescribed.

Dangerous secondary headaches like stroke or a brain infection require more intensive care, such as close hospital monitoring, intravenous (IV) medications, and/or surgery.

As with treatment, prevention depends on the type and severity of the headache.

Lifestyle modifications and pharmacologic and non-pharmacologic therapies can help prevent primary headaches.

Migraines, for example, may be prevented by avoiding triggering foods, sounds, and smells, sticking to a regular sleep routine, and engaging in certain therapies like acupuncture . For patients with chronic migraine, Botox or taking a preventive medication may be recommended.

For patients with cluster headaches, a preventive medication, like verapamil , may be advised. Adopting certain lifestyle behaviors like smoking cessation is also usually recommended.

Depending on the underlying cause, certain types of secondary headaches may be prevented.

For example, a stroke may be prevented by ensuring that risk factors like high blood pressure and high cholesterol are under control.

Likewise, a post-traumatic headache may be prevented by wearing a helmet during potentially high-impact sports or recreational activities.

Headaches that result from viral infections like the cold or flu can be prevented by washing your hands frequently and getting vaccinated, when applicable.

Most headaches are not anything to worry about and go away with medication, self-care strategies, and/or addressing the underlying cause. That said, headaches associated with certain symptoms or features like fever, neurologic deficit, pregnancy, older age, or a weakened immune system require prompt medical attention.

Headaches in the morning have multiple possible causes. They may be a primary headache like a migraine or tension-type headache. They may also arise from a hangover, caffeine withdrawal, or an underlying health problem like sleep apnea.

A tension headache (also called a tension-type headache) is the most common form of headache. It causes pressure or a tightening sensation around the head or neck and can last from 30 minutes to seven days.

There are different descriptions of headaches reported in patients with COVID-19. A typical one is a moderate-severe headache located on both sides of the head, forehead, or around the eyes, that is throbbing or pressing in nature.

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By Colleen Doherty, MD Dr. Doherty is a board-certified internist and writer living with multiple sclerosis. She is based in Chicago.

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