Migraines May Heat Up as Women Near Menopause

A new study has found that migraines worsen as women approach menopause.

“Women have been telling doctors that their migraine headaches worsen around menopause, and now we have proof they were right,” said Vincent Martin, M.D., a professor of internal medicine in the University of Cincinnati’s Division of General Internal Medicine and co-director of the Headache and Facial Pain Program at the University of Cincinnati Neuroscience Institute.

The risk for high frequency headache, or more than 10 days with a headache a month, increased by 60 percent in middle-aged women with migraine during perimenopause, the transitional period into menopause marked by irregular menstrual cycles, according to Martin, the study’s lead author.

For the study, Martin teamed with Richard Lipton, M.D., Jelena Pavlovic, M.D., Ph.D., and Dawn Buse, Ph.D., from Montefiore Headache Center and Albert Einstein College of Medicine, and Kristina Fanning, Ph.D., and Michael Reed, Ph.D., from Vedanta Research in Chapel Hill, N.C. They studied 3,664 women who experienced migraines before and during their menopausal years.

The menopausal years include both perimenopause and menopause. Menopause begins when women have not had a menstrual period for one year. Symptoms such as hot flashes, irritability, depression, and insomnia are common during both.

“Changes in female hormones such as estrogen and progesterone that occur during the perimenopause might trigger increased headaches during this time,” noted Lipton.

The risk of headache was most apparent during the later stage of perimenopause, which is a time when women first begin skipping menstrual periods and experience low levels of estrogen, added Lipton, who is also lead investigator of the American Migraine Prevalence and Prevention (AMPP) Study.

Women who participated in the study also reported that high frequency headaches increased by 76 percent during menopause, according to Martin.

However, researchers think that it may not necessarily be the direct result of hormonal changes, but rather medication overuse that commonly occurs during this time.

“Women as they get older develop lots of aches and pains, joints and back pain and it is possible their overuse of pain medications for headache and other conditions might actually drive an increase in headaches for the menopause group,” said Martin.

For the new study, researchers identified a group of women between the ages of 35 and 65 from the AMPP Study for a cross-sectional observational analysis. The AMPP Study is a longitudinal study where 24,000 people with severe headaches were followed annually over six years.

Women with migraines were asked to self-report their frequency of headaches, as well as the characteristics of their menstrual cycles. Based on the characteristics of their menstrual cycles they were placed into one of three groups: Pre-menopause (normally cycling), perimenopause (irregularly cycling), and menopause (no cycling).

For women approaching menopause and suffering from migraine there is help, noted Pavlovic.

“Physicians can prescribe hormonal therapies that level out these changes that occur during the perimenopause and menopause time periods,” she said. “If the patient is in early perimenopause, you can give birth control pills that level things out. If they are in the late perimenopause and they start skipping periods, they can be put on estrogen patches.”

The study was published in Headache: The Journal of Head and Face Pain, a publication of the American Headache Society.

Source: University of Cincinnati