One of medicine’s biggest mysteries – the reason why women are two to three times as likely as men to suffer from migraine headaches – may be on the verge of a solution.
Research presented at the International Headache Congress shows that the brains of women and men with migraine are radically different. The differences are so profound that some scientists insist that the female and male migraines are two separate and distinct disorders.
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“I strongly feel that migraine should be looked at as a different disease in women compared to men,” says researcher Nasim Maleki, medical physicist at Boston Children’s Hospital and Harvard Medical School.
If Dr. Maleki is correct, it could lead to the development of new, gender-specific treatments for migraines that are more effective than current therapies. The best available medications now work in only about half of people, leaving them to endure long stretches of excruciating pain with no hope of relief until the headache goes away on its own.
“We keep hearing about the need for individualized medicine,” Dr. Maleki tells Newsmax Health. “A good first step could be to account for something as simple as sex.”
Until recently, most researchers suggested that the usual suspect – female hormones – might be responsible for the higher prevalence of migraine in women. But they had no solid evidence to support this theory.
Frustrated by the lack of serious inquiry, Dr. Maleki and her colleagues decided to conduct MRI scans of the brains of women and men with migraines.
“I was very surprised that nobody had ever said, ‘OK, let’s take a look at the brain and see if there are any sexual differences,’” Dr. Maleki says.
“Why would researchers ignore such an important aspect of life? As much as women and men are similar, they also have very fundamental differences. If people had thought about this 40 years ago, maybe we’d have better migraine drugs today.”
The researchers found that women with migraines have a significantly different brain structure than either their male counterparts or people who don’t get migraines.
For example, they have thicker gray matter in two areas: the posterior insula, which is involved in pain processing; and the precuneus, which may be the seat of a person’s consciousness or sense of self.
The researchers also found that women who get migraines have significantly different brain function than male sufferers or people without migraines. They showed a higher degree of connectivity between the posterior insula and the precuneus. They also showed a more intense response in areas of the brain associated with emotional processing, such as the amygdala.
In men with migraines, there was a more intense response to pain in the nucleus accumbens, an area of the brain that is part of the reward circuitry and is extensively studied in addiction research.
This suggests that the brain’s reward circuitry may be involved in male migraines.
“The most interesting part of the study is the link we found between the brain’s structural differences and the functional response to pain,” Dr. Maleki says. “It seems there is a different network of structures involved in women with migraine that is not there in men with migraine.”
More research is needed to establish whether or not these brain differences are a cause or effect of migraines, she says.
Meanwhile, pharmaceutical companies should stop the practice of testing new migraine drugs on male rodents only. “It’s easier to use male animals,” she says. “But for a disease that is so sexually dimorphic, that’s the wrong way to start.”
In the near future there may be new treatments based on the brain differences discovered by Dr. Maleki and her colleagues, which would give both sexes a better chance at real relief.
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