Migraine Frequency Before, During, After Menopause
Women with migraines have often been told that their migraines will stop after menopause, and indeed, many women have held onto that statement with great hope. What women have found, however, is that there was no true predictor of the effect of menopause on migraine frequency, and the peri-menopausal period and the transitional period were even more unpredictable. Now, researchers have pulled data from the American Migraine Prevalence and Prevention (AMPP) Study to get an overview of migraine frequency during the menopausal transition. This information was presented in a research poster at the 2014 annual scientific meeting of the American Headache Society.
"To examine the relationship of headache frequency to stage of the menopausal transition in mid-life women with migraine."
"Past studies suggest that the peri-menopause is associated with an increased prevalence of migraine particularly in those with a history of premenstrual stress disorder. The effect of the menopausal transition on the frequency of headache attacks in women with migraine has not been explored."
- This research utilized data from the 2006 AMPP Study survey. This survey was selected because it included detailed questions on the menstrual cycle,
- The study sample included 3,603 women who met International Headache Society International Classification of Headache Disorders, 3rd edition (ICHD-3), criteria for migraine, ages ages 35-65 years were included in analyses.
- Women were excluded if they:
- had never menstruated,
- were pregnant,
- were breast feeding,
- using exogenous sex hormones,
- had polycystic ovarian syndrome,
- had had a hysterectomy, or
- had an oophorectomy (removal of ovaries).
- The premenopausal stage was characterized by regular menstrual cycles without variation in cycle length.
- The peri-menopausal stage included women with cycle lengths that varied by seven or more days or periods of amenorrhea lasting two to 11 months.
- The postmenopausal stage was defined by lack of menstruation persisting for 12 months or longer.
- The primary outcome, high vs low headache frequency was defined using a cut-score of 10 or more headache days per month.
Of the 3,603 women included in this study group:
- 34% were premenopausal,
- 35 were peri-menopausal, and
- 30% were menopausal.
"Frequent headache" (10 or more days per month) was 50 to 60% more common among peri-menopausal (12.2%) and menopausal women (12.0%) compared with the pre-menopausal group (8.0%).
"Consistent with the clinical impression that migraine worsens during the menopausal transition these data show that the risk of high frequency headache is 50-60% higher during peri-menopause and post-menopause as compared with the premenopause. Longitudinal studies should examine within person trajectories of headache frequency and the role of hormonal mechanisms among migraineurs during the menopausal transition."
Comments from Study Authors and Migraine Specialists:
Study author Dr. Vincent Martin commented:
"Headaches do increase during this time period. It’s what women have been telling us for years. Peri-menopause and early menopause are very turbulent times for women with migraines. Ours is the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition."
Study author Dr. Richard B. Lipton stated:
"We believe that both declining estrogen levels that occur at the time of menstruation as well as low estrogen levels that are encountered during the menopause are triggers of migraine in some women."
Dr. Andrew Charles, director of the Headache Research and Treatment Program at the David Geffen School of Medicine at UCLA said:
“This provides some hard evidence for what we’ve been seeing for a long time. What we really have to start thinking about is, are there specific types of therapies that are more appropriate for women who are having exacerbation of migraine at this time in their lives. This study charges us to get a better understanding of what exactly is going on."
Summary and Comments:
This research clearly shows a connection between migraine and the stages of menopause, a transition that every woman experiences. Too many women are told by their doctors that their migraines will stop after menopause. That obviously is not correct.
It's promising to see such excellent physicians and researchers working in this area, which impacts so many women. Now the anecdotal evidence that women have been reporting to their doctors for so long now has supported data behind it. Hopefully, this will lead to research that provides treatment strategies specifically for this period in women's lives.
Martin, V.T.; Pavlovic, J.; Fanning, K.; Buse, D.C.; Reed, M.; Derby, C.; Lipton, R.B.; Serrano, D. "The Menopausal Transition Is Associated with Higher Headache Frequencies in Women with Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study." Poster Presentation. 56th Annual Scientific Meeting; American Headache Society. Los Angeles. June, 2014.
MacVean, Mary. "Women: You are having more headaches around menopause, researchers say." Los Angeles Times. June 27, 2014.
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Reviewed by David Watson, MD.
© Teri Robert, 2014, • Last updated September 23, 2014.