Migraine: Types, Symptoms, Dealing with Them — and Differences Between Women and Men
Recurring attacks on the nervous system, agonizing headache, altered sensitivity to noise and/or light, balance disturbances, overstimulation of the gastrointestinal system. In short: migraine. It is also a classic example of how gender data gaps lead to symptoms being misinterpreted, diagnoses delayed, and therapies evaluated differently.
Putting this into the right perspective — that is the aim of today’s article.
What Does “Migraine” Mean? – Etymology and State of Research
The term migraine derives from the Greek “hemikrania” (“half skull”). The expression describes the typical one-sided headache already observed in antiquity (Pschyrembel, Clinical Dictionary).
Until the 1990s, it was assumed that the pain was caused by blood vessels in the head first constricting and then strongly dilating — and that these vascular changes triggered the pain. With modern imaging, it became clear that migraine is primarily a disorder of neuronal stimulus processing, while vascular reactions are rather accompanying phenomena. A central role is played by so-called cortical spreading depression, a wave of electrical activity spreading across the cerebral cortex, which among other things can explain aura phenomena and is associated with changes in pain and vascular regulation (Charles, 2018).
Forms of Migraine
The International Headache Society distinguishes several forms that clearly differ in symptoms and course (ICHD-3, 2018):
· Migraine With Aura: First Neurological Symptoms, Then Headache
An aura (“breath”) is a precursor neurological event. Symptoms include visual disturbances (flickering lights, zigzag lines, visual field defects), and sensory disturbances or speech problems may also occur. The aura develops gradually over minutes and resolves completely. But then there comes a storm, as the headache typically follows the aura.
· Migraine Without Aura: The Most Common Form
Characteristic are moderate to severe, usually one-sided, pulsating headaches that worsen with movement and are accompanied by nausea and sensitivity to light and sound. An attack typically lasts 4 to 72 hours.
· Menstrual-Associated Migraine
It occurs regularly in temporal association with menstruation and, by definition, belongs to migraine without aura. However, it is often more intense, longer lasting, and less responsive to medication. Estrogen fluctuations play a role.
· Chronic Migraine
In this form, headaches occur on at least 15 days per month over more than 3 months, on at least 8 of those days with migraine characteristics. It often develops from a previously episodic migraine.
· Migraine With Brainstem Aura (Formerly Called “Basilar Migraine”)
A rare form in which symptoms such as dizziness, double vision, speech disturbances, or coordination problems occur, suggesting involvement of the brainstem.
· Hemiplegic Migraine
A very rare form with temporary paralysis on one side of the body. It can occur in families (genetic origin).
Migraine: A Prime Example of Gender Data Gaps
Although migraine predominantly affects women, many older clinical studies on pathophysiology, medications, and prophylaxis were conducted mainly in men or without sex-specific evaluation. This circumstance is explicitly criticized in review articles (Vetvik & MacGregor, 2017).
Similar Symptoms Are Interpreted Differently and/or Incorrectly
The possibilities for misinterpretation are numerous.
Typical complaints include:
· Aura
· Nausea
· Sensitivity to light and sound
· Exhaustion.
Studies show that men and women experience and describe migraine differently. Men often describe neurological symptoms, pain intensity, and attack duration as less burdensome compared to women and are therefore not diagnosed as having migraine. Complaints described by women, on the other hand, are quickly classified as psychosomatic or hormonally driven. It is well documented that estrogen fluctuations can influence migraine. Historically, however, this knowledge led to migraine being categorized as a “women’s hormone problem” rather than as a neurological disorder with hormonal modulation. Alternatively, both men and women may receive the misdiagnosis of tension-type headache, as the two diagnoses are not always easy to distinguish. A thorough medical history is essential, since migraine is not diagnosed by imaging (such as MRI) or blood tests (Vetvik & MacGregor, 2017; Buse et al., 2013; Kaniecki, 2002).
Medication Studies Blind to Sex-Specific Differences
Many prophylactic migraine studies do not differentiate their results by sex, even though women are the main affected group (van Casteren et al., 2021; Alonso-Moreno et al., 2023).
This means that, to this day, we know little about whether dosage, efficacy, or side effects (should) differ in women. Few other conditions illustrate the gender data gap so clearly.
Migraine Medications: Limited in What They Can Achieve
Depending on the situation, migraine treatment includes acute medication and preventive medication. Both strategies pursue different goals within migraine therapy.
Acute medications such as triptans and NSAIDs (e.g., ibuprofen, naproxen) are used during an ongoing migraine attack.
Triptans act specifically at serotonin receptors (5-HT1B/1D), inhibit the transmission of pain signals in the trigeminovascular system, and can reduce inflammatory processes typical of migraine.
NSAIDs act primarily anti-inflammatory and analgesic. Studies show that these medications can significantly reduce or shorten an attack if taken early (Goadsby et al., 2017).
For migraine prophylaxis, medications are used that influence the excitability threshold of the nervous system and thereby reduce the frequency and sometimes the intensity of migraine attacks. Among the best-studied agents are beta-blockers (e.g., metoprolol, propranolol), topiramate, and amitriptyline. These substances have been recommended in migraine prevention guidelines for years (Silberstein, 2015).
Newer therapies target the CGRP signaling pathway, which plays a central role in migraine pathophysiology. So-called CGRP antibodies can significantly reduce the number of migraine days per month and are considered an important extension of migraine prophylaxis, especially in frequent attacks (Edvinsson, 2019).
Importantly, these medications do not automatically change factors such as sleep quality, stress processing, or individual triggers that additionally burden the nervous system in everyday life.
Holistic Measures That Stabilize the Nervous System
These need to be mentioned:
o Exercise: Regular moderate physical activity has a preventive effect
o Sleep hygiene: Regular sleep times reduce attack frequency
o Stimuli control: Consciously manage light, noise, and screen time.
In addition to medication, non-pharmacological approaches play an increasingly important role in migraine therapy. Particularly well studied are relaxation techniques, biofeedback, and cognitive-behavioral approaches. The aim is to stabilize neuronal stimulus processing and regulate stress responses of the autonomic nervous system.
o Breathing exercises — especially slow, rhythmic breathing — can promote parasympathetic activity and reduce autonomic overactivation. Although fewer isolated breathing studies exist compared to other approaches, breathing techniques are an integral part of evidence-based relaxation programs (Andrasik, 2010).
o Biofeedback is one of the best-studied non-pharmacological treatments for migraine. Patients learn to consciously influence muscle tension, skin temperature, or vascular responses. Several controlled studies show that biofeedback can reduce the frequency and intensity of migraine attacks (Nestoriuc et al., 2008).
o Cognitive behavioral therapy, stress management training, and progressive muscle relaxation can measurably reduce attack frequency and everyday burden. Unlike medications, they do not act directly on pain but intervene earlier: they help regulate stress responses, cope better with sensory overload, and change personal responses to attacks. Cognitive behavioral therapy helps patients recognize and modify stressful thought and reaction patterns. Stress management training provides strategies for dealing with occupational or emotional pressure. Progressive muscle relaxation demonstrably reduces physical tension and has a calming effect on the autonomic nervous system. In this way, the brain’s “excitability threshold” can be stabilized (Stubberud et al., 2018).
These approaches do not intervene directly in pain processing like medications, but address stimulus regulation, stress processing, and neuronal sensitization — precisely where the brain is particularly sensitive.
In our next article, we will discuss in detail which phytotherapies can be used effectively to treat migraine.
One More Thing: Is Craving Sweets a Trigger or a Warning Sign?
Many patients report a strong craving for chocolate or sweet foods hours before a migraine attack. Today, this craving is no longer hastily interpreted as a trigger. Rather, it is considered a typical sign of the prodromal phase — the early stage of an attack that precedes the actual headache. In this phase, imaging studies show altered activity in brain areas, including the hypothalamus, a brain region that regulates appetite, energy balance, and stimulus processing (Charles, 2018).
This means that the desire for sweets does not arise randomly but is part of the neurological change that has already begun. It signals that the attack has, in a sense, already started before the pain is perceived. Those who recognize this pattern can therefore understand it as a kind of warning signal. Moreover, there is no scientific evidence that giving in to this craving is harmful. Good news for those with a sweet tooth ...
Conclusion: No One Has to Simply Accept Migraine
Both women and men should be taken seriously with their complaints, because migraine is a sensitive interplay between stimulus processing in the nervous system, hormones, and everyday life structure. Anyone who truly wants to understand and treat migraine must therefore intervene exactly there — with a holistic treatment approach, not with medication alone.
FAQ – Frequently Asked Questions About Migraine
1. Why do attacks often begin in the morning or on weekends?
Changes in the sleep–wake rhythm are considered common triggers, as the migraine brain reacts sensitively to deviations in sleep duration and quality.
2. Why do darkness and quiet often help?
During a migraine attack, the brain reacts hypersensitively to light, noise, and stimuli. A low-stimulus environment can noticeably reduce this overload.
3. Can diet influence migraine?
Yes, irregular meals and significant blood sugar fluctuations are described as possible triggers.
4. How can the prodromal phase be recognized?
Typical early signs include fatigue, irritability, concentration problems — and, in many people, strong cravings for sweets.
Further information, including on many other topics, can be found alongside the blog in the volumes of our “Codex Humanus” and the “Medizinskandale” series. Feel free to visit our online shop.
Sources:
· Pschyrembel, W. (Hrsg.): “Pschyrembel Klinisches Wörterbuch,” Walter de Gruyter
· Charles, A. (2018): “The pathophysiology of migraine: implications for clinical management,” The Lancet Neurology.
· Headache Classification Committee of the International Headache Society (2018): “The International Classification of Headache Disorders, 3rd edition (ICHD-3),” Cephalalgia.
· Vetvik, K. G.; MacGregor, E. A. (2017): “Sex differences in the epidemiology, clinical features, and pathophysiology of migraine,” The Lancet Neurology.
· Buse, D. C. et al. (2013): “Sex Differences in the Prevalence, Symptoms, and Associated Features of Migraine,” Headache.
· Kaniecki, R. G. (2002): “Migraine and tension-type headache: an assessment of challenges in diagnosis,” Neurology.
· van Casteren, D. S. et al. (2021): “Sex differences in response to triptans: a systematic review and meta-analysis,” Neurology.
· Alonso-Moreno, M. et al. (2023): “Gender bias in clinical trials of biological agents for migraine: a systematic review,” PLoS ONE.
· Goadsby, P. J. et al. (2017): “Pathophysiology of migraine: A disorder of sensory processing,” Physiological Reviews.
· Silberstein, S. D. (2015): “Preventive migraine treatment,” Continuum (Minneap Minn).
· Edvinsson, L. (2019): “The CGRP pathway in migraine as a viable target for therapies,” Headache.
· Andrasik, F. (2010): “Behavioral treatment of migraine,” Neurologic Clinics.
· Nestoriuc, Y. et al. (2008): “Biofeedback treatment for headache disorders: a comprehensive efficacy review,” Applied Psychophysiology and Biofeedback.
· Stubberud, A.; Linde, M. (2018): “Cognitive behavioral therapy for migraine: a systematic review,” The Journal of Headache and Pa