Previous research has suggested that perimenopause is associated with an increased prevalence of migraine, particularly among those with a history of premenstrual syndrome. It has been theorized that changes in female hormones, such as estrogen and progesterone, that occur during the varying hormonal milieus of the perimenopause might trigger more headaches during this time.
Exploring the Issue
“Women often tell doctors that their migraine headaches worsen around menopause, but little research is available on the effect of the menopausal transition on the frequency of headache attacks in women with migraine,” says Vincent T. Martin, MD. To address this research gap, Dr. Martin and colleagues had a study published in Headache: The Journal of Head and Face Pain that examined the relationship of headache frequency to the stages of the menopausal transition in mid-life women with migraine. “This is the first study to examine this association more closely,” says Dr. Martin.
For the investigation, researchers identified the group of women aged 35 to 65 from the American Migraine, Prevalence and Prevention (AMPP) study survey and performed a cross-sectional observational analysis. The AMPP study is a longitudinal analysis in which 24,000 people with severe headache were followed annually over 6 years. “We examined more than 3,600 women who experienced migraine before and during their menopausal years in our study,” Dr. Martin says. The menopausal years were defined as including both perimenopause and menopause.
Women with migraine were asked to self-report their frequency of headaches as well as the characteristics of their menstrual cycles. Based on the characteristics of their menstrual cycles, the authors classified women into one of three groups:
- Premenopause (normally cycling)
- Perimenopause (irregularly cycling)
- Menopause (no cycling)
Among women who were premenopausal, 8% were in the high-frequency headache group, which was defined as more than 10 days with headache per month. This rate was lower than the rates of about 12% that were observed for both perimenopausal and postmenopausal women.
“The risk for high-frequency headache increased by 60% in middle-aged women with migraine during perimenopause as compared with premenopausal women,” says Dr. Martin. The risk of headache was most apparent during the later stage of the perimenopause, which is a time when women first begin skipping menstrual periods and experience low levels of estrogen.
“Women in the study also reported that high-frequency headache increased by 76% during menopause,” Dr. Martin says. “However, this finding may not necessarily be the direct result of hormonal changes as menopausal women were twice as likely to overuse acute medications to treat their headaches resulting in medication overuse headaches. As women get older, they tend to develop more aches and pains. It’s possible that overuse of pain medications for headache and other conditions might drive increases in headaches for those with menopause.”
Getting Help for Patients
Findings of the study suggest that there is a need to better optimize preventive treatments of migraine during this time of life for women. “For those approaching menopause and suffering from migraine, there are several ways that clinicians can be of help,” says Dr. Martin. “For example, we can prescribe therapies that level out hormonal changes occurring during the perimenopause and menopause time periods. If patients are in early perimenopause, they might benefit from being put on birth control pills to level out their hormones. For women in late perimenopause, estrogen patches may be considered when their periods start skipping.”
Vincent T. Martin, MD, has indicated to Physician’s Weekly that he has no financial disclosures to report.
Readings & Resources (click to view)
Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache. 2016 Jan 21 [Epub ahead of print]. Available at: http://onlinelibrary.wiley.com/doi/10.1111/head.12763/abstract.
Pavlović JM, Stewart WF, Bruce CA, et al. Burden of migraine related to menses: results from the AMPP study. J Headache Pain. 2015;16:24.
Wang SJ, Fuh JL, Lu SR, Juang KD, Wang PH. Migraine prevalence during menopausal transition. Headache. 2003;43:470-478.
Oh K, Jung KY, Choi JY, Seo WK, Park KW. Headaches in middle-aged women during menopausal transition: a headache clinic-based study. Eur Neurol. 2012;68:79-83.