Are women more prone to migraines?

“It's just a headache.” This is the biggest misconception about migraines, according to a neurologist and two women who suffer from them. The truth is, migraines are a lot more debilitating than just having pain that can be eased by taking over-the-counter medications. 

Vanessa Chia, a content creator in her 20s who goes by @wafflenessa on Instagram, remembers having her first migraine attack when she was a polytechnic student. When she got it the second and third time, she “realised it was not a one-off thing” so went to the doctor to get checked. 

Nicole, a social worker in her 40s, has been suffering from migraines for several years. They started out as tension headaches once a week that were resolved with over-the-counter medications and rest. However, the frequency of the headaches gradually increased to once every other day and the increasing pain was hard to ignore, with over-the-counter medications providing little to no relief. 

“I then decided to seek a medical opinion from a neurologist due to changes in the patterns of the headache; it was in April 2022 that I received my migraine diagnosis,” Nicole shares. “I was on oral medications until October 2023, which my doctor then switched to a monthly injection. It has been working thus far to help me manage my migraine.”

Nicole says that she's usually pain-free unless there is a sudden onset of severely-stressful situations when she is close to her monthly injection appointment. “If the pain is beyond my threshold, I will take some migraine medication,” she adds.

What do migraines feel like?

So what exactly are migraines and how are they different from headaches that most of us experience? Dr Zhao Yi Jing, a neurologist at Zhao Neurology, says that migraines are a subtype of primary headache. These are headaches not correlated with any other underlying medical condition and is a disorder of the brain itself, where the individual is more vulnerable towards experiencing headaches. This is in contrast to secondary headaches, which are due to pathology in the brain, and may be a sign of an underlying medical condition or injury.

She adds that migraine tends to be more severe than other primary headaches such as tension-type headaches. She lists some characteristics of migraines:

• A throbbing or pulsating headache
• Being one-sided
• Worsens with movement
• May cause symptoms such as vomiting, blurred vision, sensitivity to light and sound and neck stiffness.

The severity of the condition means it can affect your lifestyle. Dr Zhao shares an excerpt from one of her patients: “I can’t go to work, I can’t meet my friends or even take care of my kids. All I can do is stay in bed all day in the dark and silence, just waiting for the pain to pass. It is a sense of helplessness that I cannot describe. After an attack finally passes, it just makes me anxious about when the next attack might come. I can’t seem to enjoy life anymore.” 

Dr Zhao says that, for individuals living with chronic migraines, the condition significantly hampers their ability to participate in social activities, fulfil work obligations and attend to their familial responsibilities. 

“These are basic daily tasks that we take for granted but for my patients who grapple with migraine attacks, it’s not something they can enjoy,” she explains. “Chronic migraine sufferers frequently express a sense of loss, feeling as though the condition has deprived them of the simple joys of everyday life, leading to persistent anxiety and apprehension regarding the onset of the next migraine attack.”

Vanessa admits that she always worries “that a migraine attack may occur literally anytime or anywhere”. Also, because her eyes are very sensitive to bright lights (eg. flashing lights or sunlight), she is very wary of this and brings shades everywhere she goes. 

Nicole says that having migraines has affected her lifestyle, especially at social gatherings or work as they tend to strike without warning. She has had to cut short gatherings or attempt to complete her work task or meeting as soon as possible to manage the pain, especially when she's caught without her medications on hand.

“Before my migraines were properly managed, I spent more time at home and deliberately planned my activities to be of the shortest duration to avoid, as much as I could, the possibility of a migraine occurring,” she adds. 

The oestrogen factor

According to a 2020 study, the lifetime prevalence of migraine in Singapore is 8.2%. The study also found that these are the groups more likely to experience migraines: 

• Malay ethnicity (compared to Chinese)
• Diploma holders (compared to degree holders)
• Younger age group of 18-34 years (compared to 65 years and above)
• Employed people (compared to economically inactive people)

Another interesting finding is that the prevalence of migraine becomes higher in females after puberty – three times more common. This higher prevalence lasts all the way till menopause, after which it declines but still remains higher than in males. 

The obvious culprit here is none other than our pesky female hormones. Dr Zhao reveals that one of the reasons why women are more prone to migraine is because the condition is heavily influenced by the fluctuation of oestrogen (a type of female hormone) in our body. 

“Due to the fluctuating hormone levels based on an individual’s menstrual cycle, during periods of pregnancy as well as during the perimenopausal years, it will affect the frequency of migraines,” she says. 

Dr Zhao says that women are twice as likely as men to suffer from migraines, and the frequency, duration and disability of attacks also tend to be higher in women as compared to men. She adds that migraine attacks in women are likely to peak between the ages of 30 to 50 years old, during the most productive years in both our professional and personal lives. Therefore, for women suffering from migraines, it is crucial to seek medical help.

Getting support from loved ones

Because migraines can be debilitating, it's important for women to share their migraine experience with their loved ones and how they may help them during a migraine attack, says Dr Zhao. This is especially important as migraine is an invisible condition.

“If you have a loved one suffering from migraines, it is important to understand that migraine is not just a headache. It is a headache that can be very severe and debilitating and there may be instances that migraine sufferers may not be able to function during migraine attacks,” she says. 

Nicole has shared her diagnosis with her close loved ones and her workplace. She says that they have been “pretty understanding and would check in on how I am coping from time to time”. 

Vanessa has done the same and her loved ones give her support whenever she's going through a migraine attack. However, when she was working as an intern, her workplace “thought that I was trying to fake a medical certificate because I had migraine attacks twice during the span of my internship”.

Nicole encourages migraine sufferers to seek medical treatment as getting an early diagnosis is helpful towards long-term management of the condition. “Migraine can be managed effectively once medical treatment begins. Knowing the triggers would be helpful as it differs from individual to individual.”

Vanessa hopes changes can be made to make our environment more conducive for migraine sufferers: “People who have aura migraines like me are more sensitive to light. I have encountered coffee shops in Singapore that are too brightly lit and this may trigger migraines. I hope we can get some support in making sure light around us in our country is not too glaring.”