Menopause May Increase Migraine Frequency
Many women have been told that their migraine frequency will lessen with menopause. However, women have been telling their doctors for years that their migraine attacks increase with the transition to menopause (perimenopause) or in menopause (postmenopause. Perimenopausal and postmenopausal women had an increase in their migraine frequency, according to a study presented at the American Headache Society meeting in June.
Researchers concluded that women in perimenopause or postmenopause were 50% to 60% more likely to have 10 or more headache days per month in this study of 3,606 women aged 35 to 65. About a third of the study’s participants were premenopausal, a third were in perimenopause and a third were in postmenopause. The percentages of who had 10 or more headache days a month were:
- 8% of premenopausal women
- 12.2% of perimenopausal women
- 12% of postmenopausal women1
(Are you wondering why this says “headache days” and not “migraine attacks”? All the participants of the study had migraine, but researchers asked about number of headache days rather than number of migraine attacks. This is the preferred question in research and in clinical practice. Many physicians believe that when a migraineur has a non-migraine headache, migraine is still the source of that headache, it’s just not a full-blown migraine attack. By asking about headache days rather than migraine days, they get a better picture of what migraine is like for each patient.)
Hormonal changes are thought to be responsible for the difference in migraine frequency. According to lead researcher Vincent Martin, M.D., “I think that estrogen is the most important hormone, but also think that other hormones such as progesterone can play a role as well.” Follicle-stimulating hormone (FSH) may also be a factor. 2,4
I asked Dr. Martin if the research contradicts the belief that migraine frequency lessens with menopause. He said, “No, I don't think so. I think our research suggests that the transition into menopause increases the frequency of headache. The perimenopause (particularly the late perimenopause) seems to have the highest frequency of headache compared to premenopausal times.” The degree of disability associated with the migraine “was only increased in the perimenopausal group suggesting that this is the most important times for worsening of headache that likely represent migraine,” Dr. Martin said.3
Most of the participants had been postmenopausal for a short time, so findings can’t be extrapolated through the entire postmenopausal period. It could be that late perimenopause and early postmenopause are the most likely time period for increased migraine frequency. A 2003 study found that women in late perimenopause had the highest migraine prevalence and women who had gone through spontaneous (not surgically induced) menopause had the lowest.4
The study gathered data from a slice of time and did not assess a participant’s migraine history prior to then. Therefore, the data do not show if a woman had frequent migraine attacks prior to that time period or at what stage in menopause (pre-, peri- or post-) the increased migraine frequency began.
When the news of this study first came out, I actually cried. I thought of all the women (including myself) holding out hope that their migraine frequency and severity will lessen with menopause. Upon further investigation, I discovered that this study does not necessarily dash those hopes. The research is in the very early stages and many questions remain before we can draw conclusions. Instead of seeing this study’s findings as bleak, I’m encouraged that researchers are trying to understand the problem. That’s the first step in figuring out how to treat it.
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