Women often experience perimenopausal changes in headache frequency, when migraines may worsen or new types of headaches begin. The following case series describes a possible new type of chronic daily headache that appears to develop in overweight/obese women around the time of menopause or after.1
The case series concerns eight women who were seen by a single neurologist at the Mayo Clinic, Jacksonville, FL over the course of one year. All the women described recent onset (within the last year) bilateral daily head pain. Pain was worse in the morning just before rising from bed, with reported intensity ranging up to 10/10. Only one out of the eight women described co-occurring migraine features. None were able to identify triggers.
The average age of onset was 57 years (two women were perimenopausal, the remainder were menopausal). Six out of the eight had a history of episodic migraine, which was either well controlled or in remission when the new headache symptoms started. Six out of the eight were either overweight or obese.
All patients had normal ophthalmic exams, with no evidence of disc edema. Trendelenburg in the 10 degree head-down tilt position precipitated immediate worsening of symptoms in all patients. MRI with or without contrast and MR venography were normal, except for small incidental venous anomalies in three patients. Lumbar puncture (LP) was performed on two patients and showed normal to low opening pressure. Both developed post-LP headaches.
LP was not deemed curative. All women showed rapid response (within 2 to7 days) with near complete resolution of symptoms when treated with acetazolamide (7 patients) or spironolactone (one patient). All experienced headache recurrence when tapering off medication, and none were able to completely taper off medication.
1. Rozen TD. A new subtype of chronic daily headache presenting in older women. J Women’s Health (Larchmt). 2018;27:203-208.