It’s Official: Your Family Can Give You a Headache

A 13-year-old girl wakes up several mornings with intense pain and can’t function in school. The 34-year-old female CEO of an Internet start-up misses a week of work every month, leaving her team without direction. What do they share in common? Both suffer from painful migraines induced by a change in hormones. And both may have close relatives with the same health issue.

Headaches can be debilitating, especially those severe in nature, such as migraine and cluster. Even tension headaches, a tamer cousin, can leave a person wanting to crawl into a dark hole. While we’re still learning about the cause of headaches, we do know they are linked to gender and heredity, a connection especially clear with migraines.

“In general, migraines are three times more common in women than men (with an incidence of 18.2 percent in women vs. 6.5 percent in men), and most women with migraines have a first-degree relative with migraines,” says Stephen Silberstein, professor of Neurology at Thomas Jefferson University in Philadelphia and director of the Jefferson Headache Center. “It’s a combination of genetics and hormones.”

How Hormones Fit In

If you crave chocolate and are in a not-to-be-messed-with mood, tell your friends to watch out. You may be expecting your period—and a migraine.

Migraines are more likely to affect women between puberty and menopause, though they are most common in women between 35 and 45. This is in part because hormones, especially estrogen, play a large role in migraines. “It is the decline of estrogen, not the surge, that triggers headaches, not the steady high levels, but the rising and falling,” Silberstein says.

More than half of women who have migraines report headaches associated with their menstrual cycle. The prevalence of headaches in boys and girls is equal up until girls begin puberty, says Silberstein. After puberty, a woman has more migraine headaches than a man, a pattern that continues until she is past menopause.

Fluctuations in hormones that occur throughout a woman’s life can cause more migraines. Changing hormone levels associated with perimenopause can make migraines worse, as can changing hormones within a pregnancy. Many women susceptible to migraines have an increased rate after childbirth, once their hormone levels return to normal.

Conversely, taking birth control pills can stabilize a woman’s hormone levels—and,  in doing so, decrease her number of migraines. Hormone replacement therapy  can affect migraine rate too, Silberstein says. Women who use HRT in tablet form have an increase in migraines because they experience a surge and decline in hormones. Women who receive HRT through a patch get a steady dose of hormones and do not have an increase in migraines.

Heredity a Headache Link, Too

If your mom or your aunt were waylaid by migraines, it’s more likely you will be, too. Many people with migraines report a family history, so it is thought that heredity plays a role. In fact, 40-50 percent of the susceptibility to migraine is genetically based, according to at least one source. This is especially true with migraines that come with visual symptoms, called an “aura.” “Genetics is more important for migraines with aura than without aura,” though only 20 percent of patients with migraines experience an aura, Silberstein says.

It’s thought that people with migraines may inherit abnormal genes that control the function of specific brain cells. A sensitivity then triggers the migraine. In the case of migraines with aura, the person can see flashing lights or zigzags, develop a short-term blind spot, or temporarily lose sight.