Does migraine start in the womb?

Twin brother promotes migraine

Probably the biggest surprise came from a closer look at the fraternal twin pairs: “Migraines occurred more frequently in women with a twin brother than in women with a female twin,” the researchers write.

The researchers had originally expected the opposite. This is because one hypothesis about the imbalance in the migraine risk of men and women is that testosterone tends to lower the risk, while higher estrogen levels increase it.

Experiments with laboratory rodents had previously shown that a male twin with its testosterone production ensures a “slight masculinization” of the hormonal climate in the common womb.

Transformed Testosterone

In the female twins, scientists subsequently found more testosterone in the blood and less estrogens throughout their lives than in conspecifics who had shared the mother’s womb with sisters. According to the study, even in the case of mixed-sex human twins, the presence of the brother should have protected the sister from migraines.

There is the following conceivable explanation for the fact that this is not the case: The female fetus converts testosterone into estrogen by means of another hormone, according to one hypothesis of the researchers. In fact, female foetuses can respond in an appropriate way to testosterone from the mother. As a result, estrogen levels would then even rise.

Similar effects would therefore not necessarily be limited to fraternal twin girls: they could also affect foetuses whose mothers have comparatively high testosterone levels.

Hormones reprogram genes

Another hypothesis: In response to the higher testosterone levels, the girls could also develop a higher number of estrogen receptors later in life – and accordingly react particularly sensitively to the hormones.

Such adaptations of the body to environmental factors arise via so-called epigenetic programming. In this process, switches are flipped on the chromosomes that regulate the activity of genes. Such an epigenetic orientation has a lifelong effect. In this way, the physical processes of the children are already adjusted in the womb.

For example, it is known that diet, stress or even overweight of the mother influence the development of the child via metabolism and hormonal factors. High blood sugar levels but also stress hormones then program the children for their lives.

Is estrogen a migraine driver in women?

There have been numerous indications that sex hormones could contribute to the sex difference in the frequency of migraines. For example, the “estrogen withdrawal hypothesis” suggests that changes in the level of estradiol in the blood can trigger migraine attacks.

Another observation supports this hypothesis: Before puberty, when the sex hormones are still largely inactive, migraines occur equally frequently in boys and girls. Women also suffer from more frequent attacks during menopause with its hormonal turbulence. When estrogen levels drop significantly after menopause, seizures become less frequent.

What role genes play

In addition, Fitzgerald’s team also investigated whether the different high migraine risk of men and women is due to the influence of genes.

The scientists investigated whether migraines are equally hereditary in men and women or whether environmental factors play a greater role in one sex. However, they found no difference: According to the twin data, the share of genes in the migraine risk was 45 percent each. The remaining 55 percent is due to development and environmental factors.

The researchers also found no migraine risk genes that occur either only in men or only in women. In addition, known dominant risk genes, which are sufficient for all to trigger migraine development, did not occur more frequently in any of the sexes. It was only when the scientists took a closer look at risk genes, which only have an influence on migraine in interaction with others, that they found differences between men and women.

Overall, the sex differences in the risk of disease seem to be attributable to genetic factors only to a small extent.

“The better we understand the factors that contribute to migraine and in particular the differences between men and women, the better we can improve therapeutic measures for men and women,” explains study leader Mathew Panizzon.

Why twin studies are so valuable

If you want to track down the influence of genetic causes of diseases, such twin studies provide a real treasure trove of information. While identical twins have identical genes, the genes of fraternal twins only match 50 percent on average – as with all other siblings.

If the two groups are compared, it is possible to determine what influence the genes have on the development of certain traits or diseases, and how high the influence of environmental factors is.

Causes of migraines – No different in the UAE

Migraines are a common neurological condition worldwide, and the UAE is no exception. Studies indicate a significant portion of the population suffers from migraines, though exact prevalence rates may vary. In the UAE, the hot climate can be a significant trigger for migraines. Dehydration, due to high temperatures, can exacerbate migraine symptoms

A 2018 study found that approximately 20% of UAE residents experience migraines, which aligns with global estimates.

Health insurance in the UAE typically covers consultations and treatments for migraines, although coverage specifics can vary between providers and plans. It’s essential for members to check their individual insurance plans for details on coverage for both conventional and alternative treatments.