Migraine in perimenopausal women

Abstract

Hormonal changes during the reproductive cycle are thought to account for the variation in migraine occurrence and intensity. Although the majority of women and the specialists treating them do not consider migraine as a component of the climacteric syndrome, many women, in fact, do experience migraine during perimenopause. If a woman already suffers from migraine, the attacks often worsen during menopausal transition. Initial onset of the condition during this period is relatively rare. Women with the premenstrual syndrome (PMS) prior to entering menopause are more likely to experience, during late menopausal transition, an increased prevalence of migraine attacks. Hormone replacement therapy (HRT) can be initiated during the late premenopausal phase and the first years of postmenopause to relieve climacteric symptoms. The effect of HRT on migraine, either as a secondary effect of the therapy or as a preventive measure against perimenopausal migraine, has been variously investigated. HRT preparations should be administered continuously, without intervals, to prevent sudden estrogen deprivation and the migraine attacks that will ensue. Wide varieties of formulations, both systemic and topical, are available. Treatment with transdermal patches and estradiol-based gels is preferable to oral formulations as they maintain constant blood hormone levels. Natural menopause is associated with a lower incidence of migraine as compared with surgical menopause; data on the role of hysterectomy alone or associated with ovariectomy in changing the occurrence of migraine are till now unclear.

Male and female sex hormones in primary headaches

“…An early stage that lasts 5 to 8 years, characterized by amenorrhea length more than 1 year, low estrogen levels and high FSH level. The late stage is characterized by stable low levels of ovarian hormones [92].…”

“…As perimenopause and menopause consist of several phases, each with a unique hormonal pattern, they all have a different effect on migraine. Another important factor is whether the menopause is naturally or artificially induced and whether HRT is used [92].…”

I Ching Balance Acupuncture Treatment of Migraines, Insomnia, and Depression in a Post-Ovariectomy Patient Receiving Hormone Replacement Therapy

“…1 Migraines, insomnia, and depression are among the symptoms associated with surgical menopause. 1,2 It is known that surgical menopause is associated with a higher incidence of migraines, compared to natural menopause. 2 In addition, Ripa and associates reported that postmenopausal hormone-replacement therapy <HRT> was associated with worsening migraines.…”

“…1,2 It is known that surgical menopause is associated with a higher incidence of migraines, compared to natural menopause. 2 In addition, Ripa and associates reported that postmenopausal hormone-replacement therapy <HRT> was associated with worsening migraines. 3 As shown by Chubaty et al, following surgical menopause, women receiving or not receiving HRT equally reported sleeping difficulty.…”

Migraine during perimenopause

“…Many women experience migraine approaching menopause, but the trend of migraine symptoms may vary according to the different stages of the perimenopause. If a woman is already a migraineur subject, the attacks often worsen during both the early and late phases of menopausal transition, whereas an onset of migraine is quite rare[ 1 ]. According to some authors, women with premenstrual syndrome (PMS) before menopause have an increased prevalence of migraine in late menopausal transition, and a subsequent reduction of the attacks in postmenopause[ 2 ].…”