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Expert Answer: Hemiplegic Migraine & Menopause: What Happens?

Unfortunately, there is no good data to predict if a female with hemiplegic migraine (temporary one-sided paralysis) will experience more or less migraines when she is menopausal. Here is what we do know: The prevalence of migraine decreases in both men and women with age. For women migraine sufferers, studies indicate that 2/3 will experience improvement of their migraines when they become menopausal. However, this 2/3 (66%) improvement is only for women who go through menopause spontaneously. If women have their ovaries removed as if often done with a hysterectomy (removal of the uterus), they fare far worse and only 1/3 will experience an improvement in their migraines with menopause. The take-home lesson here is to not rush into a complete hysterectomy unless medically necessary for reasons other than migraine headaches.

Women with menstrual migraine would be expected to notice more improvement in their migraines with menopause as they no longer have the hormonal fluctuations that are felt to be the greatest trigger for menstrual migraine. By definition, menstrual migraine is migraine without aura. However, my opinion is that women with aura including the more complicated aura called hemiplegic migraine may also have a hormonal trigger to their migraine attacks. By eliminating the ups and downs in estrogen and progesterone that characterize a women’s menstrual cycle, the hormonal trigger is removed and so I would expect less migraine attacks.

It may be useful to think about what happens during pregnancy. Estrogen levels rise, become quite high and then stay high and fairly constant until delivery. Women who have migraine without aura usually have fewer migraines during pregnancy. However, women who have migraine with aura (and hemiplegic migraine is a type of migraine with aura) often do not improve during pregnancy so for these women, the high levels of estrogen may be having a negative impact on their aura and migraines. In fact, if migraine occurs for the first time during pregnancy it is often migraine with aura.

In some sense, menopause can be considered the opposite of pregnancy since there are very low to no-existent levels of estrogen in menopausal women compared to the very high levels during pregnancy. Therefore, I predict that for most women who have migraine with aura, including hemiplegic migraine, they would experience improvement with menopause.

What would then happen if the woman with hemiplegic or migraine with aura was given exogenous estrogen in the form of an estrogen pill, patch, or cream? I think there is a chance that the estrogen treatment could negatively impact her hemiplegic migraines. Therefore, I would probably suggest alternative non-estrogen treatments for the woman with hemiplegic or migraine with aura headaches if she was symptomatic with hot flashes, night sweats, or insomnia. Options include Effexor, Gabapentin, and Prozac: all have been shown to reduce menopausal symptoms and all have shown some benefit in migraine prevention.

In conclusion, I feel that estrogen, both endogenous (from a woman’s own ovaries) and exogenous (birth control pills; hormone therapy), can be a trigger for aura and for hemiplegic migraine. Therefore, the low estrogen state of menopause could be favorable for a woman with hemiplegic migraine and I predict her migraines may improve. More research needs to be done in this area!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Karen Stanley Haack
    8 years ago

    Thank you for your response to my question. However after seeing every specialist in the book we now know that sami has histamine intolerance and is allergic to over 40 foods mostly fruits vegetables, nuts and lot of medications. The medications she was given for her migraines were histamine liberaters making her condition worse. ‘She was fainting and suffering from paraplegia. We eliminated all of the known allergens, and foods with high histamine levels. She has not had an episode since Feb. We found out because they did a MRI with contrast media and it almost killed her. Just want to thank you for responding and let you know. Samantha unfortunately still has not had a period in four years. Since her first Gardasil vaccine which I know caused all these problems.

  • TiciaNiemi
    8 years ago

    What about those of us that have FHM type 1 (Familial Hemiplegic Migraine Type 1)? I have had migraines all my life, and I had uterine cancer when I was 26 this resulted in a full radical Hysterectomy. My Hemiplegic migraines have worsened over the years and now I have them 2 to 3 times a month. No one seems to know how to deal with them. I take Calcium Channel Blockers and Vitamin B2 and Magnesium Sulfate. When my attacks start I have Fiorinal and when they last for 3 days I go get treatments of DHE. I just want them to go away….

  • Tonya Cramer
    8 years ago

    I am not sure I belive this–i suffer with the hemiplegice migraines for over the last ten years–i have been tested for everything under sun with false reults. I have been told there is no connection with my monthly cycle since I have an iud. I am not in menapause–so if u have a clue as to why I get these please enlighten me. I saw the worlds specialist in migraines and he was unable to help me since he found no cause for my pain that I live in 24hrs a day 7 days a week–52 weeks a year.

  • Karen Stanley Haack
    8 years ago

    could be histamine intolerance and food allergies. look into that.

  • Debbie Jones
    8 years ago

    Due to endometriosis I had to have a hysterectomy when I was 39 yrs. old, I am now 51. Definitely no change in my migraines and have taken Estratest since the surgery. I would have to say the only time I was migraine free was in my 2nd and 3rd trimester of pregnancy. Birth control pills were an absolute trigger for me, I can’t even explain how bad the pain was when I took the “pill”.

  • Susan Lucas Derouin
    8 years ago

    I also had a hysterectomy at 30. My migraines started after the birth of my daughter. I ‘ m 61 and still have migraines.

  • Nancy Orlando-Bell
    8 years ago

    Relief from Migraines after Menopause/ I am still waiting and praying everyday. Nancy Orlando

  • Pen Ort
    8 years ago

    Mine started with menopause, they continue to worsen 5 years on.
    Please ladies dont ever rely on them abating after “the change”. For most, they do not. I hope you are the exception.

  • Angie Leblanc
    8 years ago

    I cant wait till am done am in the middle right now and when I didn’t have my monthly for 5 months last yr it was great no migraines and 4 months this year cant wait maybe I can have my life back when am done.come on Post menopause.

  • Lori Glasgow-Brininger
    8 years ago

    I’m almost 3 years post-menopausal and haven’t had much change in my migraines. But after reading this, I realized that the migraines with aura (I’d get maybe 4 per year) have lessened! I still get weather-triggered migraines, but living in the midwest isn’t the best for those!

  • Danita Villarreal Heersche
    8 years ago

    come on menopause! I hope I would be one of the ones that will benefit from menopause in gettng rid of my migraines. I am for take it all out, now.

  • Dr Hutchinson author
    8 years ago

    Yes, if women are considering a hysterectomy for medical reasons such as migraine, then a trial of a “medical menopause” or what you call a chemical menopause makes sense. For readers who aren’t familiar Zoladex,it is a GnRH agonist and suppressed the production of estrogen. The main indications for its use include estrogen-related breast cancer, endometriosis, and uterine fibroids. An example of another common GnRH agonist is Depo-Lupron, commonly used for endometriosis. There are side-effects to medications that are “anti-estrogen” such as hot flashes, night sweats and increased risk of osteoporosis. However, these “medical” or “chemical” menopause-induced states are reversible unlike surgery so I agree with Ellen to test the waters of menopause before undergoing a surgery with irreversible consequences.

  • Ellen Schnakenberg
    8 years ago

    Dr Hutchinson,

    I’m wondering if you would be willing to discuss chemical menopause here, for those women who may be considering hysterectomy for health reasons…

    As a patient advocate, I strongly encourage patients in the process of this decision to talk to their doctors about Zoladex or other comparable medication, that would allow them to experience menopause and potentially either a decrease or increase in their Migraines. Unlike surgery, this is reversible.

    I discuss my own experience with “trying out” menopause before committing to it in this post: “Will a Hysterectomy Cure My Migraines?” http://bit.ly/bMnWKl

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