Migraines in women worsen as menopause sets in

A new study provides evidence for what many women have long known—migraine headaches worsen with the beginnings of menopause, according to results published online January 21, 2016, in the journal Headache: The Journal of Head and Face Pain.

The risk of high headache frequency (10 or more days of headache per month) increased by 60% in middle-aged perimenopausal women with migraine as compared with premenopausal women, found researchers from the University of Cincinnati (UC) in Cincinnati, OH, Montefiore Headache Center in Bronx, NY, Albert Einstein College of Medicine in Bronx, NY, and Vedanta Research in Chapel Hill, NC.

“Women have been telling doctors that their migraine headaches worsen around menopause, and now we have proof they were right,” said the study’s lead author Vincent Martin, MD, Professor of Internal Medicine in UC’s Division of General Internal Medicine and co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute.

The researchers used data from the 2006 American Migraine, Prevalence, and Prevention (AMPP) survey to study 3,664 women diagnosed with migraine before and during their menopausal years (between ages 35-65). Participants reported their headache frequency as well as the characteristics of their menstrual cycles, from which they were classified into pre-menopause (normally cycling), perimenopause (irregularly cycling), and menopause (no cycling) groups.

The risk of headache was most significant during the later stage of perimenopause—a time when women first begin skipping menstrual periods and experience low levels of estrogen, said Richard Lipton, MD, Director of the Montefiore Headache Center, and Professor and the Edwin S. Lowe Chair in Neurology at Albert Einstein College of Medicine.

“Changes in female hormones such as estrogen and progesterone that occur during the perimenopause might trigger increased headaches during this time,” said Dr. Lipton, who is also lead investigator of the AMPP study.

Study participants also reported that high frequency headaches increased by 76% during menopause. However, researchers surmised that this finding was not necessarily due directly to hormonal changes, but rather to medication overuse that commonly occurs during the menopausal phase.

“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,” Dr. Martin said. 

Given the study’s findings of an increased risk of high frequency headache during the menopausal transition, there’s a need for better preventive treatment of migraine during this time, said co-author of the study Jelena Pavlovic, MD, PhD, attending physician in Neurology at Montefiore and Assistant Professor of The Saul R. Korey Department of Neurology at Einstein.

“Physicians can prescribe hormonal therapies that level out these changes that occur during the perimenopause and menopause time periods,” Dr. Pavlovic 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.”