It’s a bit of a cliche isn’t it? The stereotype of the headachey woman who uses ‘one of her heads’ as an excuse for anything from not wanting sex to skiving off work or just not wanting to deal with an emotionally-tense situation. As with most stereotypes there is certainly some truth in this one – science has proven that women really do suffer from more headaches. But science has also shown that headaches are not just in women’s ‘heads’ – in their minds – and we now understand much better why women are more prone to headaches than men.
It’s not that long ago that many doctors believed that headaches in women were due to ‘hysteria’ and an inability to manage stress. Women who experienced headaches (or mental health issues) were often ridiculed and dismissed when seeking help for their headaches and even seen as malingerers.
Thankfully our clinical understanding of headaches has moved on significantly with the advancement of research and clinical practice in fields including endocrinology, imaging and pharmacology. Historically the vast majority of medical research has been carried out using male patients but we increasingly understand that in many ways women’s bodies do not respond in the same way as men’s. In the case of headaches there are different things happening physiologically in the bodies of men and women, and ultimately, headaches are rooted in biology.
Many studies have been conducted that suggest women are more prone to migraines (around 3 times as many women as men) and they’re actually more prone to other types of general headaches as well.
One of the biggest reasons why women get more headaches is hormone fluctuation during the menstrual cycle. Oestrogen is a hormone that has been closely linked to headaches and it is much more prevalent in women. Both in terms of headaches and other types of chronic pain there is evidence that levels of pain tend to vary based through a woman’s menstrual cycle, and that some pains feel worse during the premenstrual period and during menstruation.
There’s also a phenomenon called cortical spreading depression (CSD) that is believed to cause headaches, and evidence that women may have a lower threshold for CSD compared to males. Another theory is that females have thicker gray matter in parts of the brain that manage pain processing, whereas other studies point to adverse childhood experiences and more exposure to physical abuse as reasons why women have more headaches.
Researchers have also found that women tend to experience stronger episodes of chronic pain that lasts longer than men. This goes beyond pain in the head and can extend to the neck, back, knee, and shoulder too. Other conditions, like fibromyalgia, rheumatoid arthritis, and irritable bowel syndrome, are also more common among women. When several of these conditions occur simultaneously in the body, the pain can become unbearable and lead to psychological problems and permanent disability. Too often these pain symptoms and conditions are seen and treated as ‘separate’ illnesses where they may actually have similar underlying causes and ‘interact’ with one another. Treatment for some conditions can even have side effects that worsen other pain symptoms (have a look at the possible side effects leaflets of many over the counter and prescription medications and ‘headaches’ will very often be inclued).
Men and Headaches
Although women are more prone to headaches overall, that certainly doesn’t mean that men don’t get them. Younger boys have more headaches than young girls – until girls reach puberty. Although headaches are more common among women there are specific types of headaches that disproportionately occur in men – cluster headaches, for example, are six times more frequent in men. Men in their 20s to 50s are most likely to develop these types of headaches, with genetics, smoking, and alcohol use
Some psychologists and doctors believe that in general, men focus on the physical effects of pain, while women focus on the emotional effects. Since emotions associated with pain are usually ‘negative’, those who focus on emotions may feel a second dimension of pain on top of the physical.
What can you do about your headaches?
If you suffer with severe or frequent headaches it can be debilitating. Fortunately in the vast majority of cases the underlying causes are not sinister (e.g. brain tumours) but it can be frustratingly difficult to identify what factors are causing your particular headaches to recur as it is often a combination of things.
There are a number of underlying medical conditions that can cause chronic headache symptoms – for example anaemia (low iron, B12, folate), Vitamin D deficiency and menopause – many of which can be checked for with a blood test and are quite easily treated. If you suffer with chronic headaches and your GP hasn’t spoken to you or looked into these possibilities it’s well worth speaking to them again.
Having an understanding of some of the things that can cause headaches specifically in women and keeping a headache diary might help you to identify patterns and triggers for your headaches and this can also be really useful information for your doctor or clinician. Your doctor may be able to advise lifestyle changes that might help – for example, reducing consumption of alcohol, caffeine and carbonated soft drinks.
If you’ve ruled out any sinister or underlying causes, tried some lifestyle adjustments, and you find that you are still having headaches, you might consider a consultation with a physical therapist – like a chiropractor or osteopath who specialises in treating patients with chronic headaches. Recurring headaches can often originate from, be made worse by, or be accompanied by, symptoms in the face, jaw, neck, shoulders, and upper back. By looking at the patterns of tension and alignment in your whole upper body, and treating areas surrounding and connecting into your head, therapists may be able to help you to achieve a gradual – or in some cases a rapid- improvement in both the frequency and severity of their headaches.
For many headache sufferers even knowing that their headaches are not ‘all in their head’ and finding a clinician who is able to look at their headaches from different perspectives and ‘believes’ them can be a powerful first step.