When it comes to physical suffering, nature has not divided it fairly between the sexes. Women often turn out to be the losers. They bleed every month and give birth to children. As if that were not enough, they are also more likely to suffer from chronic conditions, such as migraines. What’s up with that?
Hereditary factors play a major role
Migraines are caused by an overstimulation of the brain. Some kind of short circuit. What causes this temporary disruption? Scientists and doctors have been researching this for years.
So is Gisela Terwindt. She is a neurologist at the Leiden University Medical Center (LUMC). ‘We now know that migraine is very hereditary,’ she explains. ‘In previous studies we have identified 123 pieces of DNA that play a role in the development of migraine. As a person with migraine you may have fifteen or twenty genes that are responsible for it.’ That’s good to know, but not very useful in practice. If there are so many causes and combinations at the genetic level that cause migraines, it is almost impossible to come up with targeted solutions.
In women, hormones may be the culprit
The fact that women suffer from migraines more often is an important fact. ‘Women often get migraines at certain times in their lives. Before puberty, boys and girls suffer about the same amount. After puberty, girls suffer three times as often, and migraine often occurs for the first time,’ says Terwindt. An improvement is usually seen during pregnancy. But during the menopause, migraine can worsen again or even arise for the first time. We already knew that the difference between men and women with migraine has nothing to do with X or Y chromosomes. So we started looking at hormones.’
Migraines often occur around menstruation
‘Especially to estrogen and progesterone, two of the most important groups of sex hormones,’ says Britt van der Arend, research physician at the LUMC Headache Research Group. ‘Almost everyone knows that one, they are the two substances that are also in the combined contraceptive pill.’
‘We found out that migraines in women often start around the first day of menstruation. At that moment there is a sudden drop in hormones
estrogen and progesterone in the body. You don’t see that at any other time in the menstrual cycle. Then the theoretical thought arose: would that drop lower the threshold for a migraine attack?’
WHAT study provides more clarity
At the LUMC, Van der Arend is mainly concerned with the WHAT-studie (Women, Hormones, Attacks and Treatment). That study started about five years ago and focuses specifically on the relationship between women, migraine and hormones. The study consists of three parts. The first part, a diary study into individual causes of migraine, has now been completed. Five hundred women kept a diary via an app. Not only did they indicate whether they had migraines or not, they also had to answer all sorts of questions. Were they menstruating at the time? Did they take the pill?
‘That first study showed the importance of the research. Not only did we find out that there is a link between migraine and menstruation, but also that attacks occur differently during menstruation. They are more serious, last longer and medication works less well during that period or the headache comes back more quickly.’ The results formed the starting point for the second part (hormone measurements) and the third part (trial with the contraceptive pill) of the study. Both are still running.
Do not look for solutions yourself
This research is desperately needed, because many women with migraine go in search of solutions on their own. For example, they ask their GP for the contraceptive pill or an IUD, even though they don’t know how to use them for migraines. ‘How this works has not been thoroughly investigated,’ says Terwindt. So there are two dangers involved. First, women are prescribed the pill and the doctor tells them to take a week off. But if you have a stop week, the drop in hormones will still take place, so the pill will not work against migraines. Second, the pill is not candy. There are side effects and you have a slightly increased risk of a cerebral infarction or heart attack. Starting with the pill at random can do more harm than good.’ In addition, it remains to be seen: does it work at all if you equalize hormonal levels?
Future music: hormone pill specifically against migraine
What does the future hold for women with menstrual migraines? Terwindt and Van der Arend hope that the WHAT study can solve even more riddles surrounding migraine. In the future, they even hope to be able to make a hormone pill specifically for migraine. ‘It will hopefully be lighter than the contraceptive pill, with fewer side effects. And maybe you don’t have to take it all month, just in the period around your period, “says Terwindt.
Would you like to know more about the WHAT study or participate in the research? Which can!
2023-07-20 17:36:06
#women #suffer #migraines #men
