At the 56th Annual American Headache Society conference in June, researchers presented evidence that when it comes to migraines, men and women may have completely different disorders. They discovered structural and functional differences in the way the brains of male and female migraineurs process pain. We now have the beginnings of a biological explanation for the stereotype that women are more sensitive to pain, suffer emotional pain in connection with physical pain, and feel pain more deeply. This same evidence offers possible reasons why men tend to not experience emotion as intensely during physical pain. Thanks to this discovery, we may soon have a biological understanding of the link between mind and body, too.
Migraines in men
In response to painful stimuli, the pleasure centers of the male brain were activated. These centers are located in the nucleus accumbens which is the reward circuitry closely associated with addiction. More studies are needed to understand how pain, pleasure, and addiction are interrelated. It is commonly understood that men are more prone to addiction while women are more prone to migraine.
Migraines in women
Three times more women than men experience migraine. It is so common, than one in four women will have migraine in her lifetime. What has not been fully understood is why this occurs. Thanks to Nasim Maliki and her team of researchers, we have learned that there are physiological differences between men and women who experience migraine. Maleki explains, “The brain of a female migraineur looks so unlike the brain of a male migraineur that we should think of migraines in men and women as ‘different diseases altogether’.”
What is not clear is whether or not the differences contribute to female susceptibility or if they are changes caused by the presence of migraines.
Given the same painful stimuli, the emotional processing centers of the female brain were activated. Essentially, a woman who experiences physical pain will also experience emotional pain while a man in pain will not. The strongest responses in women were in the emotional networks, including the amygdala, the insula, and the precuneus. Essentially physical pain triggers emotional pain, resulting in significantly greater perception of suffering among women than men.
Let’s take a closer look at the three areas of the brain most involved in female migraines.
The amygdala is responsible for our emergency response system commonly known as “fight or flight”. There is greater activity in the amygdala of female migraineurs during an attack, indicating that women are more likely to feel fear, anxiety, and increased stress in combination with a migraine attack than men. They are also more likely to seek emergency medical help for a refractory migraine as the danger alarms in their brains fire much more readily.
The precuneus is hidden deep inside the brain near the vision centers of the brain. It is responsible for visuo-spatial imagery, retrieving memories of experiences (as opposed to rote learning), self-consciousness, and altered mental states (sleep, drug-induced anesthesia, and vegetative states). The anterior portion of the precuneus maintains the functions of mental imagery, including visual memory while the posterior precuneus supports experiential memory retrieval. Its link to memory may explain why so many female migraineurs complain of memory loss and/or impairment during an attack.
Researchers have discovered a possible link between mind and body through the insula, a region of the brain largely ignored due to the difficulty in studying it and its placement near the primitive brainstem. The insula is like a hub, connecting bodily functions to the emotion pathways of the brain. It is essentially the mind-body connection. It was assumed to be just one more part of the primitive functions of the brain. That was, until fMRI scanning became possible. Now for the first time, scientists are able to view its activity in response to a variety of stimuli.
Implications for further research
The mind-body connection: While only mentioned in passing, this discovery is exciting in that it demonstrates in inseparable link between the mind (though, emotion, belief) and the physical body. It validates the need for a multidisciplinary approach to care that includes routine mental health services.
Researchers recommended that future studies should test men and women separately in order to work on gender-specific treatments. They also expressed hope that future treatment developments will take gender differences into account when developing and testing new drugs and other treatments.
From the perspective of stigma, the news is very validating to female patients, especially those who struggle with mood and anxiety disorders in addition to migraine. As doctors and patients begin to understand that an individual’s response to pain is rooted in the way his or her brain functions, more compassion and understanding will hopefully lead to better treatment, especially in emergency situations.
For centuries women’s health concerns have been minimized and ridiculed as “hysteria”. Women have been brushed off, ignored, and accused of exaggerating their pain based on the perceptions of a male-dominated society incapable of experiencing the same level of anguish because their brains do not permit them to feel it. When men realize that they really don’t understand the pain a woman experiences and women learn that their agony is genuinely a result of the way their brains function, perhaps we can all take each other’s pain a lot more seriously.
What everyone needs to learn
Women are not exaggerating their pain. They genuinely feel mental and emotional pain with the same intensity as the physical pain during a migraine attack.
Men’s lack of emotional response is not because they lack feelings, but because the emotional pathways of the brain do not fire when they experience a migraine attack.
Doctors need to be willing to treat the emotional symptoms of migraine with the same seriousness as any other symptom. They also need to learn how to communicate the rationale for their referral to mental health services to minimize the risk that patients will think they’ve been labeled “crazy”.
Patients need to understand that in the absence of effective drug treatments, mental health services may be recommended to help manage the emotional symptoms of migraine. Cognitive behavioral therapy has a good track record of success in treating chronic pain. Just because your doctor recommends therapy, does not mean he or she thinks you are crazy