Gender-related differences in migraine
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Gender-related differences in migraine Gianni Allais 1 & Giulia Chiarle 1 & Silvia Sinigaglia 1 & Gisella Airola 1 & Paola Schiapparelli 1 & Chiara Benedetto 1
# The Author(s) 2020
Abstract Migraine is considered mostly a woman’s complaint, even if it affects also men. Epidemiological data show a higher incidence of the disease in women, starting from puberty throughout life. The sex-related differences of migraine hold clinical relevance too. The frequency, duration, and disability of attacks tend to be higher in women. Because of this, probably, they also consult specialists more frequently and take more prescription drugs than men. Different mechanisms have been evaluated to explain these differences. Hormonal milieu and its modulation of neuronal and vascular reactivity is probably one of the most important aspects. Estrogens and progesterone regulate a host of biological functions through two mechanisms: nongenomic and genomic. They influence several neuromediators and neurotransmitters, and they may cause functional and structural differences in several brain regions, involved in migraine pathogenesis. In addition to their central action, sex hormones exert rapid modulation of vascular tone. The resulting specific sex phenotype should be considered during clinical management and experimental studies. Keywords Gender . Migraine . Neuromodulation . Progesterone . 17 beta-estradiol
Introduction Migraine is generally considered a woman’s complaint owing to its preponderance among women and the greater healthcare resource use by women for migraine headache. Epidemiological data subdivide the prevalence of migraine by age group. In prepubertal children, the 1-year prevalence is roughly the same for boys and girls (overall range, 2–5%; 2.4% and 2.5% in girls and boys, respectively, aged 7–9 years; 5.4% and 3.9% in girls and boys, respectively, aged 10–12 years) [1]. Starting at puberty with its accompanying hormonal changes, the prevalence increases in both sexes, and it is higher in girls than boys from 13 to 15 years (6.4% and 4.0%, respectively). This sex-related difference in prevalence remains throughout life. Between 10 and 20% of women report experiencing their first migraine attack at the start of menarche [2]. Migraine incidence peaks first at around age 35 years (25–30% of women and 8% of men) [3] and then again at around age 50, after which it declines with advancing age [4]. The elderly suffer less frequently from migraine but more often from secondary headache than young
people. The decline in migraine frequency is proportional to advancing age, starting at the sixth/seventh decade, and further decreases after age 75. Nevertheless, new onset migraine after age 65 is noted to occur in 0.5% of the population [5]. The American Migraine Prevalence and Prevention (AMPP) study reported a cumulative incidence of lifetime migraine in 43% of women and 18% of men [6], a slightly lower rate than more recent data reveal, according to which the risk of migraine is 3.25 times higher for women than fo
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