Renowned GP and television personality Dr Amir Khan has provided a clear explanation for why some individuals, particularly women, suffer from debilitating migraines more than others, offering hope for more effective, tailored treatments.
The Physiology Behind the Pain
The NHS describes a migraine as a severe, throbbing headache, typically felt on one side of the head. Sufferers often endure a host of other symptoms, including nausea, vomiting, and an increased sensitivity to light and sound. These painful episodes can last anywhere from a single hour to several days, severely impacting daily life.
For some, an 'aura' precedes the headache, manifesting as visual disturbances like bright flashing lights or physical sensations such as tingling in the face or limbs. While the exact cause of migraines remains somewhat elusive, research strongly points to a combination of genetic and environmental factors.
Hormonal fluctuations are now understood to play a pivotal role. This connection helps explain why migraines are frequently linked to a woman's menstrual cycle, pregnancy, and the menopause. A 2023 study starkly highlighted this disparity, finding that one in five women of reproductive age suffers from migraine.
Oestrogen: The Key Hormonal Trigger
Dr Khan, known for his work demystifying health issues on TV and social media, stated that migraines tied to your period, ovulation, pregnancy, or perimenopause are not random events but are driven by physiology.
"Oestrogen doesn't just control periods; it has receptors all over the brain," Dr Khan explained. The hormone influences blood vessels, nerve sensitivity, and critical pain-processing areas like the trigeminal nerve. When oestrogen levels are stable, the brain remains calm. However, a sudden drop in oestrogen makes the brain more excitable and sensitive, dramatically increasing the likelihood of a migraine.
The main circuit involved in migraine pain is the trigeminal pathway, which runs across the face and into the brain. Low oestrogen makes this nerve easier to activate. When it fires, it releases chemicals, notably one called calcitonin gene-related peptide (CGRP).
"This causes blood vessels to widen, the brain tissues to become more inflamed, and that classic throbbing pain to begin," said Dr Khan. Oestrogen normally helps suppress CGRP, but when hormone levels fall, CGRP surges, amplifying pain signals. This discovery has led to the development of new migraine medicines that target CGRP directly.
Three Critical Times for Hormonal Migraines
Dr Khan identified three primary times when a drop in oestrogen can trigger an attack. The first and most significant is just before a period, which sees the steepest oestrogen drop of the entire menstrual cycle. The second is around ovulation, where a smaller rise and fall can set off a migraine in susceptible women.
The third major trigger is perimenopause. "Hormones are swinging wildly. One day high, next day low," Dr Khan noted. This hormonal volatility is why many women first develop migraines in their 40s or find their existing migraines become dramatically worse.
He also highlighted that oestrogen influences serotonin, the hormone affecting mood and gut function. As oestrogen drops, serotonin can also dip, which is why hormonal migraines often come with nausea, mood changes, and light sensitivity.
Dr Khan emphasised the profound gender disparity, noting that after puberty, women are up to three times more likely to be affected by migraines than men. "This tells us this is hormonally driven, not just in your head, and definitely not something to put up with," he asserted.
His final advice offers a clear path forward for sufferers: "So if your migraines follow a pattern, whether it's monthly, pre-period, or during the perimenopause, it's your hormones interacting with your brain's pain circuits. And once we can identify your pattern, we can tailor treatment much more effectively."
