Migraine affects women more often than men, and the divergence begins around puberty. The timing pattern in many patients points toward hormonal fluctuation as a contributing factor.
The sex difference appears at puberty
Migraine prevalence is similar in boys and girls before puberty and diverges afterwards, with the gap persisting through the reproductive years.
That timing implicates the hormonal changes of puberty rather than something inherent from birth, and it is one of the clearer clues about mechanism.
The pattern shifts again around menopause for many people, which is consistent with a hormonal contribution rather than a fixed characteristic.
Falling estrogen appears to be the relevant trigger
Attacks in menstrually related migraine cluster around the days when estrogen levels drop, rather than when they are simply high or low.
The change appears to matter more than the absolute level, which is why stable periods, including some phases of pregnancy, are associated with fewer attacks in many patients.
Estrogen influences several systems involved in migraine, including pain signaling pathways and blood vessel behavior, though the full mechanism is not settled.
Migraine is more than a headache
Attacks typically involve additional features such as nausea, sensitivity to light or sound, and functional impairment, and may include aura with visual or sensory symptoms.
Recognizing it as a neurological condition rather than a severe headache matters, because the distinction affects how it is evaluated and managed.
Underestimation is common, and attacks are frequently absorbed into ordinary life without being recorded or discussed with a clinician.
Tracking is how patterns become visible
Because attacks are irregular, a link to cycle timing is difficult to notice without records kept over several months.
A simple log of attack dates, duration, cycle timing and other suspected triggers gives a clinician information that recall alone cannot supply.
This is also how genuine triggers are separated from coincidence, since single occurrences invite explanations that repeated data does not support.
Where clinical assessment is required
Migraine with aura interacts with certain decisions about hormonal contraception, which is a matter for a clinician rather than general reading.
A sudden severe headache unlike previous ones, headache with neurological changes, or a marked change in an established pattern warrants prompt medical evaluation.
Treatment options exist across several categories and are chosen based on individual history, so decisions about them belong with a physician or neurologist.