Questions This Article Answers: How many women get migraines compared to men? Can I take migraine medicine during my pregnancy? What are menstrual migraines and how can I treat them? An estimated 30 million Americans suffer from migraines—about 10% of the U.S. population. Men and women experience many of the same migraine symptoms, including intense pain that can last from a few hours to two days, nausea, vomiting, heightened sensitivity to light and sound, or even temporary loss of vision or speech. However, there are some key differences in how migraines affect women compared to men. Women make up 75% of migraine sufferers, and have reported more intense pain levels. Knowing these unique risk factors can help women avoid common triggers, prevent migraine attacks, and find effective treatment. Women are more likely to have migraines. In childhood, boys are more likely than girls to experience migraines. But as girls’ estrogen levels start to increase during puberty, so does their rate of migraines. In the United States, 18% of adult women suffer from migraines, compared to just 6% of men. Recent studies have also found a link between migraine and cortical spreading depression, a wave of electrical stimulation in the brain followed by nerve cell inactivity that’s more common in women. Migraines can increase a woman’s chance of stroke. Cortical spreading depression is specifically seen as a cause of the aura—bright spots of light, flashes, blind spots, or tingling in the hands or face—that can accompany migraines. One study showed that women under 45 who experience migraines with aura have an increased risk of ischemic stroke, which occurs when a blood vessel to the brain becomes blocked. Additional factors can increase stroke risk for women with migraines. Stroke risk triples for female migraine suffers who smoke, and women with migraines who both smoke and use birth control pills have a seven times greater risk of stroke. Menstruation can bring on migraines—and make them more severe. Girls are more likely to have their first migraine during the year of the onset of menstruation than during any other time of their lives. About 10 to 14% of women experience “menstrual migraines,” which occur anywhere from 2 days before to 3 days after the start of their period. It’s not estrogen itself that triggers these migraines, but the sudden fluctuation in hormone levels. Women report menstrual migraines are more painful and difficult to treat than migraines experienced at other times of the month. In some cases, doctors may consider using hormonal contraceptives as a treatment option for menstrual migraines. Hormonal birth control can cause mixed effects for women with migraines. Because changes in estrogen and progesterone are such potent triggers, migraines are most common in women between ages 20 and 45, when stress and hormonal fluctuations are at their peak. Changes in hormone levels due to the use of birth control pills or other methods of administering hormones (vaginally, by patch, or by injection) can affect migraines; while some women feel better, others actually experience intensified frequency and duration. Pregnancy can affect a woman’s migraines in many different ways. Fortunately, about two-thirds of women who are prone to migraines notice the frequency actually lessens during pregnancy. (This is more likely if migraines were generally worse around a woman’s period or started at the original onset of menstruation.) Some women notice no change due to pregnancy, while others find their headaches become more frequent and intense. In some cases, women who have no previous history of migraines experience their first one during pregnancy, often in the first trimester. All women should consult with their doctors about migraine treatment options during pregnancy, as some migraine medications may harm the fetus. Menopause can mean the end of migraines—but not at first. In the initial onset of menopause, known as perimenopause, migraines can actually worsen due to the dramatic hormone fluctuations women experience. But for 67% of women who reach menopause—defined as 12 months without a period—migraine symptoms improve significantly or even disappear altogether. Women who go through a surgical menopause following the removal of the uterus or ovaries may find their migraines intensify more than women who reach menopause naturally. In both cases, the use of hormone replacement therapy can have varied effects on migraine symptoms, so women should talk to their doctors about the risks and benefits of HRT. Women can be more susceptible to environmental migraine triggers. More women than men report migraines due to changes in the atmosphere, such as sudden thunderstorms, abrupt changes in altitude or barometric pressure, windstorms, and seasonal changes. Some experts suggest people with frequent migraines have lower thresholds for pain or are more sensitive to environmental changes, including weather. For women who experience weather-related triggers, keeping a journal can help track conditions that most often lead to a migraine so you can be prepared to take medication at the first sign of symptoms. Each phase of life can bring new challenges for women living with migraines. By working closely with all of your doctors, you can stay ahead of your symptoms and find the right migraine treatment plan for you.