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7. Who gets migraine and other headaches?

Headaches can affect anyone, at any time, for many different reasons and for no reason at all. Different people cope with headaches differently and different people perceive and experience pain differently.

Heredity and Gender

Both my partner and I suffer from migraines. Does this mean that our children will probably have them too?

Your children will be more likely to develop migraine than if neither one of you had migraine. A first-degree relative – a sibling or a child – is more likely to develop migraine than someone in the general population. There is no guarantee that they will develop migraine but, if the right triggers come together, they are more likely to have an attack. There is some evidence to suggest that this is more likely with migraine with aura.

There are various studies that have looked at just how many children suffer from migraine.

I’ve heard that migraines are hereditary – both Mum and Dad get them, so is that why I get them as well?

The simple answer to that is ‘Yes’. Studies have found that 50% of people with migraine know of a relative who has migraine, and as many as 90% have a first-degree relative (parent, sibling, child) who has migraine.

My sister told me that an article she read says that migraines get better as you get older. I hope this is right!

Generally, migraine does become less common as you get older.

Headaches can still occur but they may not be due to migraine. The type of headache may change with age: for example, tension-type headache due to neck problems, temporal arteritis or an increase in migraine due to the menopause.

Is it true that people with certain personalities are more likely to get migraine?

Anyone can get headache and no one particular personality is more likely to get headache or migraine than any other. But some people cope better with pain than others. Some people are tuned in to possible triggers or things that push their migraine threshold down, so they are more likely to get migraine. Self-awareness, knowing and understanding how things affect you, and insight, recognising that things need to change, can be relevant to managing and coping with headaches.

As children, my brother got migraine and I didn’t; now that we are teenagers, I get migraine and my brother doesn’t. Any idea why?

The facts seem to be that boys are affected more commonly than girls, but in adulthood, women are more commonly affected than men. Why this is so is less clear but, as the change occurs at or around the time of puberty, there is an assumption that the female hormone oestrogen is the likely reason.

Why are more women affected with migraine than men?

There is no doubt that more women are affected by migraine than men. It is assumed that, because this shift occurs around the time of puberty, oestrogen is the reason for this change.

There is evidence that some women get a migraine headache at the start of their period and that this is associated with the size and rate of the fall in oestrogen levels. In addition, a significant proportion of women who have migraine, especially the type without aura, tend to become migraine-free during pregnancy, a time when oestrogen levels are stable.

Is it true that men are more likely than women to have cluster headache?

Yes, that does seem to be the case. Women can get cluster headache but it is much more common in men. Nevertheless, it is a very rare condition, only 0.5% of the UK and other European countries population being affected.

I understand that migraines are more common in women and cluster headaches are more common in men. Do other types of headache show a difference between the sexes?

Statistics indicate that:

• Tension-type headache affects both men and women, but 90% of women are affected compared with 70% of men

• Cluster headache affects more men than women in a ratio of 3:1

• Coital headache can occur at the start of sexual activity or at orgasm; it is more common in men but does occur in women as well, the ratio is about 4:1

• Paroxysmal hemicrania is more common in women than in men in a ratio of 3:1

Are there any racial differences between who gets migraine and who does not?

Ethnic and cultural differences in people who get migraine headaches and those who don’t may be related to perception and coping strategies. Nevertheless, ‘white’ (Caucasian) people seem to be affected more than Afro-Caribbean and Asian people.

My mother suffered quite badly with migraines and I get them, too. Is migraine inherited?

Familial hemiplegic migraine is a migraine that runs in families (hence the term ‘familial’) and causes paralysis down one side (hemiplegic). It is a genetic condition that has been linked to specific genes on particular chromosomes and is transmitted as an autosomal dominant characteristic. ‘Autosomal dominant’ means that you need only one parent to have the gene for you to inherit/develop the  condition.

The gene in the case of familial hemiplegic migraine is located on chromosome 19.

The abnormality is present on the cell membrane, which controls the passage of calcium, sodium and potassium in and out of the cell. When the relevant gene is present on chromosome 19, the passage of calcium through the membrane is abnormal; this alters the ‘conductivity’ of the nerve cell, which predisposes to migraine.

For those of you who feel like trying to understand a little more, read on . . .There are three ‘loci’, points, on chromosomes – FHM1, FHM2 and FHM3 – each associated with a specific chromosome and gene. The defect associated with locus FHM1 is on chromosome 19, specifically 19 p13. The gene has been identified as CACNA1A. The defect associated with locus FHM2 is on chromosome 1, specifically 1q21-q23.

The gene has been identified as ATP1A2.

The defect associated with locus FHM3 is on chromosome 2, specifically 2q24. The gene has been identified as SCN1A.

These defects are associated with a variety of channelopathies.

A channelopathy is a condition or disease that involves the ion channels in cell membranes and how ‘ions’ (calcium, sodium and potassium) move across cell membranes. If these ions do not move freely and normally, the cell does not perform its normal healthy function and disease results.

The CACNA1A gene is associated with P/Q-type calcium channels, the ATP1A2 gene is associated with a sodium/potassium transportation mechanism and the SCN1A is associated with a sodium channel protein.

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