The Role of Gender in Migraines and Strokes

Migraines are a female thing. At least that is the impression you get when clicking around websites from the medical community and self-help organizations. They are filled with images of women holding their temples and grimacing in pain. Similar images of men, however, are scarce. Migraines are certainly considered a typical female condition, and in fact statistics show that women suffer from migraines two- to three-times more often than men. Indeed, migraines have acquired a rather questionable reputation. For example, in his 1931 novel Dot and Anton, Erich Kästner described them as follows: “After lunch Mrs. Pogge had a migraine. Migraines are headaches when you don’t actually have a headache.” 
 

Even today, migraines continue to be portrayed as an imaginary illness. “Migraines are still very stigmatized,” says the neurologist Susanne Wegener. “Anyone who suffers from them knows that this stigma is really unfair.” These intense headaches, which can be accompanied by nausea, fatigue and other symptoms, are extremely debilitating. “Migraine is undoubtedly a physical disorder that is very real and can be clearly diagnosed,” adds Wegener. 

Women are by no means the only ones who struggle with migraines’ debilitating symptoms. Migraine is certainly a male disorder as well – but men talk less about their migraines than women do and, similar to depression, seek help less often from a physician. For example, from a physician like Susanne Wegener, a professor at the University of Zurich. In addition to researching the causes of and treatments for headaches, migraines and strokes, Wegener sees patients at the University Hospital Zurich. Sex-specific factors play an important role in both her research and clinical work. A close connection exists between the body’s biology and gender-specific social factors. In terms of biology, for example, it is now known that the sex hormone estrogen protects women from migraine attacks. Presumably, this is the case with testosterone in men as well. However, hormonal fluctuations – especially when hormone levels fall, as happens during the female cycle – make people more susceptible to migraines. Therefore, women are especially at risk of getting migraines during their periods. “That is why it’s good to know that using certain types of birth control that keep hormone levels stable can alleviate symptoms and reduce migraine attacks,” states Wegener.

Another common trigger for migraine attacks is more related to social factors: stress. This troublesome phenomenon is becoming increasingly widespread in society. “Women seem to react more sensitively to stress because their sympathetic nervous system – or their stress nervous system – is activated more quickly than men’s,” explains Wegener. She is convinced that in order to reduce stress, and in turn people’s susceptibility to illnesses such as migraines, more emphasis needs to be placed on prevention. This could equally benefit both women and men.

This conviction is the reason why Wegener and the Swiss Headache Society worked together to develop a concept for promoting migraine-friendly workspaces (www.headache.ch). “When a company creates workspaces that allow people with migraines to withdraw and their coworkers to understand their situation, employee satisfaction increases and illness-related absences decrease,” says Wegener. This benefits not only those suffering from migraines but also their employers.

Wegener specializes in not only headaches but also strokes. Overall, more women die following a sudden disruption of blood flow in the brain than men. Such strokes occur primarily in older women because – as with migraines – estrogen has a protective effect when they are younger. Since women in Switzerland live on average four year longer than men and the risk of stroke increases with age, strokes occur in women over 75 much more often. In other words, longer life expectancy is one reason why more women have strokes than men.

Not only are there more female stroke patients, but women also fail to recover from a stroke as well as men. And this is despite men and women benefiting equally from acute care in the hospital, a fact Wegener was able to confirm in a study. “These gender-specific differences are likely related to age as well,” she concludes. Older women live alone more often because their husbands have passed away. Consequently, when they have a stroke, they receive less support after being released from the hospital. For example, when they should go to physical therapy for further rehabilitation but no one can go with them, they often stay home instead. And this has a negative impact on their recovery process. 

So in comparison to men, women's recovery from a stroke is much poorer and, on average, they are less fit a year after a stroke. “We have increasingly more knowledge about gender-specific risk factors and biological differences when it comes to strokes,” says Wegener. “In contrast, we still know relatively little about the social factors that influence stroke progression and recovery.” Closing this knowledge gap and acquiring new insights on this topic is the aim of the National Research Programme 83 “Gender Medicine and Health” that was launched at the end of last year and whose steering committee includes Wegener. 

This article is part of the dossier on gender medicine from UZH Magazin 1/24.