Migraines in women: why they affect women more and what we know today about hormones and the brain

There are illnesses whose presence is obvious, and others which, precisely because of their prevalence and adaptability, end up becoming a silent part of the daily lives of those who suffer from them.

Migraine often falls into this second category.

Perhaps this is because, for a long time, it was reduced to an overly simplistic image: that of a severe headache that comes and goes. However, anyone who lives with this condition knows that it is rarely limited to the painful episode itself. The experience usually begins before the pain starts and continues afterwards. It can manifest as difficulty concentrating, a persistent feeling of exhaustion, increased sensitivity to everyday stimuli, or the hard-to-describe sensation that the brain is functioning differently on those days.

For this reason, although pain remains the most visible symptom, migraine bears less and less resemblance to what we traditionally imagined when we spoke of a headache.

Today, we understand migraine as a complex neurological condition.

This means that the pain does not depend solely on a specific structure, nor does it arise as a result of a single identifiable abnormality. Systems involved relate to how the brain processes information, regulates certain biological signals and responds to internal and external stimuli.

When we talk about sensory processing, we are referring precisely to the brain’s ability to receive information from the environment and from the body itself — such as light, noise, sleep, stress or hormonal changes — and to decide which signals to amplify, which to filter out, and how to respond to them.

Within this evolution of our understanding, one particularly striking observation has stood out.

Migraine clearly affects women more than men.

And understanding why this difference occurs is helping not only to better understand the condition, but also to rethink how we study it and how we treat it.

The short answer… and the full answer

If we had to answer the question in the title of this article in a single sentence, it would probably be this:

Migraine affects women more because certain hormonal variations appear to interact with brain systems involved in pain regulation and may alter susceptibility to developing certain attacks.

But that explanation remains insufficient. We now know that hormones alone do not fully account for the phenomenon.

Current research points to a considerably more complex interaction between hormonal regulation, brain function, pain processing and individual biological differences that we are still trying to understand.

And this is precisely where neurology is beginning to shift the conversation. This reality often emerges long before a patient reaches a specialist clinic.

Dr Rocío García-Ramos, a neurologist and head of the neurology department at the Publio Cordón Memorial Hospital, explains that one of the most striking aspects of migraine is precisely its ability to become progressively integrated into everyday life to the point where it is no longer recognised as a condition warranting specific attention.

As she summarises: “Migraine is a condition that often reaches the doctor’s surgery late. Not because it appears late, but because many people learn to live with it. There are patients who have spent years reorganising their schedules, avoiding plans or anticipating difficult days, thinking they simply have a tendency towards headaches”.

He adds a point that neatly sums up one of the hidden problems of this condition: “Normalising a symptom does not necessarily mean it is normal.”

This clinical observation is particularly interesting because it shifts the focus away from the painful episode towards something less visible: the way in which a common condition can gradually become a new way of organising one’s life.

Why does migraine affect women more?

The available data reveal a pattern that is hard to ignore.

Before puberty, boys and girls experience migraines with relatively similar frequency. However, following hormonal development, a gradual divergence emerges that persists throughout much of adulthood.

It is currently estimated that migraine affects women approximately two to three times more often than men. For years, this difference was interpreted almost exclusively from a hormonal perspective. However, recent research has begun to reveal a considerably more complex reality.

An international review specifically dedicated to studying sex differences in migraine found that women not only had a higher prevalence, but also experienced more frequent, longer-lasting attacks, greater recurrence and a slower return to normal function following each episode.

The authors suggest that these differences likely reflect an interaction between hormonal regulation, brain sensitivity, pain processing and neurobiological mechanisms that are still evolving.

The implication of this new way of interpreting the data is particularly interesting. The question no longer seems to be solely why migraine is more common in women.

The question is beginning to shift to how certain biological characteristics modify the way the condition manifests itself.

Migraine in Spain: figures and why many women delay seeking medical advice

When we observe this reality in our own surroundings, the scale of the phenomenon becomes more tangible.

According to data from the Spanish Society of Neurology, more than five million people live with migraine in Spain and approximately one and a half million suffer from chronic migraine.

Furthermore, around eight out of ten patients are women. But perhaps the most interesting statistic is not how many people live with migraine, but rather how many end up adapting their lives to it before considering that there might be another way of living with the condition.

Hormones and migraine: what we know today about oestrogen and the brain

If migraine affects women more, it is natural to wonder whether the answer lies simply in hormones. For a long time, that was precisely the prevailing hypothesis.

Today we know that hormones probably do not cause the condition, but they can alter the biological environment in which it arises.

To understand this, it is worth considering a simple idea: the brain does not respond in the same way at every stage of life, nor does it always maintain the same threshold in response to certain stimuli.

One of the molecules that has attracted the most interest in recent years is CGRP (Calcitonin Gene-Related Peptide).

Although the name may sound technical, it is a molecule involved in communication between structures related to migraine and plays a part in mechanisms that facilitate the transmission and amplification of certain pain-associated signals.

A recent review focusing on migraine throughout a woman’s life specifically analysed the relationship between oestrogen and this system and described how certain hormonal fluctuations could alter this signalling and increase the brain’s susceptibility to developing certain attacks.

Talking about brain susceptibility does not mean talking about a diseased brain. It means understanding that certain circuits may have a different threshold for responding to stimuli that would go unnoticed in other people.

Drawing on her clinical experience, Dr Rocío García-Ramos explains that this shift is also changing the way she talks to many patients.

“When a woman recognises a link between migraine and her hormonal cycle, the aim is no longer simply to tell her that it’s normal or that she’ll just have to live with it. The key is to try to understand the pattern: the timing, the frequency, how the intensity changes, and how it actually affects her life.”

This is because such an analysis often provides particularly valuable clinical information to help guide the best course of treatment.

How neurology understands migraine today

Perhaps one of the most significant conceptual shifts currently taking place in neurology is the move away from seeking a single explanation for all cases.

More and more researchers are realising that migraine can arise as a result of a complex interaction between biological predisposition, brain function and exposure to certain internal and external factors.

Sleep.

Stress.

Hormonal changes.

Diet.

Environmental factors.

None of these factors affect everyone in the same way.

And that idea shifts the focus away from searching for a single cause towards trying to understand individual patterns.

Research into and management of migraine in women

A better understanding of the relationship between migraine, hormones and the brain is also transforming the way this condition is studied.

Today, a specialist assessment is no longer simply a matter of confirming or ruling out a diagnosis.

The aim is to understand how attacks occur, how they relate to each patient’s biological context, and how they affect their daily lives.

Dr Rocío García-Ramos explains that a significant part of clinical work consists precisely of identifying connections that often remained invisible to the patient themselves.

As she summarises: “A significant part of the consultation involves identifying patterns that the patient has often not linked together. When the attacks occur, how they progress, which stages of the cycle affect them, which activities the patient has stopped doing, or what they hope to resume.”

She adds a particularly relevant point: “Clinical information remains an extraordinarily valuable tool for making more accurate decisions.”

This evolution in our understanding is also changing the way we organise clinical care. Because if we increasingly recognise that migraine can manifest differently depending on the individual and their stage of life, it follows logically that the assessment should become more specific.

At the Publio Cordón Memorial Hospital, we have the Headache, Migraine and Women’s Unit, led by Dr Nuria González García, which focuses on research and an individualised approach from a perspective that integrates the neurological, hormonal and functional context of each patient.

As Dr González explains: “We are coming to understand more and more that migraine does not manifest in the same way at every stage of a woman’s life. Identifying patterns, understanding the real impact on quality of life and developing strategies tailored to each situation are all part of a more personalised approach to care.”

The aim is therefore no longer simply to reduce the number of attacks. It also involves restoring functionality, peace of mind and quality of life.

 The next step: understanding better to treat better

Perhaps one of the most interesting developments currently taking place in neurology is not the discovery of a single cause for migraine. Perhaps it is the realisation that not all migraines tell the same story.

And that gaining a better understanding of who is affected, when it occurs and how it alters daily life may be just as important as understanding what happens inside the brain.

Some clinical questions arise precisely when we stop assuming that living with pain is part of the norm.

The information contained in this article is for general information purposes only and is not a substitute for an individual medical assessment.

The information in this article is provided for general awareness and does not replace an individualised medical assessment.