The frequency of migraine attacks is higher in women during perimenopause and postmenopause than in premenopause, according to the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition.
“Fluctuating estrogen levels play an important role in initiating migraine in women,” study co-author Richard B. Lipton, MD, Co-Director of the Montefiore Headache Center and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine, told ConsultantLive.
“Migraine onset increases with menarche and is more common around the time of bleeding during the menstrual cycle,” he said. “The trigger factor is thought to be declining estrogen levels. As menopause approaches, estrogen levels fluctuate and likely trigger migraine.”
Dr Lipton noted that estrogen and other sex hormones act on the brain and alter the excitability or sensitivity of the nervous system.
The research was conducted as part of the American Migraine Prevalence and Prevention (AMPP) Study, a longitudinal mailed questionnaire survey of 120,000 households selected to be representative of the US population. Data from the 2006 AMPP Study survey were used. Women with migraine aged 35 to 65 years were eligible for the analyses.
Women with migraine were classified based on headache frequency. A high-frequency group experienced 10 or more headache days per month, and a low- or moderate-frequency group experienced episodic migraines on fewer than 10 days per month.
The women also were classified based on menopausal status. The premenopausal stage was characterized by regular menstrual cycles. The perimenopausal stage included women with cycle lengths that varied by at least 7 days or periods of amenorrhea lasting 2 to 11 months. The postmenopausal stage was defined by amenorrhea persisting for at least 12 months.
The analysis included more than 3600 women, mean age 45 years, with about one-third of them in each of the 3 groups. Frequent headache (10 or more days per month) was 50% to 60% more common among perimenopausal women (12.2%) and menopausal women (12%) compared with premenopausal women (8%).
Consistent with the clinical impression that migraine worsens during the menopausal transition, these data show that the risk of high-frequency headache is greater during perimenopause and postmenopause as compared with premenopause, Dr Lipton said.
The researchers concluded that longitudinal studies should examine within-person trajectories of headache frequency and the role of hormonal mechanisms among migraineurs during the menopausal transition.
“In the present report, we compared groups of women who were premenopausal and perimenopausal and postmenopausal in the year of the study,” Dr Lipton said. “In a longitudinal study, we would follow individual women as they transitioned from premenopausal to perimenopausal to postmenopausal and examine the hormonal changes that underlie changes in headache frequency.”
He added: “Clinicians should know that headaches may get worse as women begin the menopausal transition. When patients experience migraine worsening, clinicians can explain that hormonal changes may be driving the changes. Controlling headache is one factor that may contribute to the complex decisions about when to recommend hormone replacement therapy.”
The researchers presented their results on June 20, 2014 at the 56th Annual Scientific Meeting of the American Headache Society in Los Angeles.