The impact of midlife on migraine in women: summary of current views

Abstract

Migraine is three times more common in women than in men and is the 4th leading cause of disability in women. Onset of migraine increases at menarche, with peaks in prevalence in the late 30s, and a rapid decline after menopause. While the prevalence is highest among women of childbearing age the frequency of headache and burden of migraine frequently worsens during midlife. Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. The midlife worsening of migraine is attributed to hormonal fluctuations characteristic of the menopausal transition. Drops in estrogen presumably lead to increased migraine attacks at the time of menses as well as during the menopausal transition. During the menopausal transition, recommended approaches include both acute and preventive non-hormonal and hormonal options as well as behavioral approaches. Herein, is a brief review on the presentation of migraine in women across the lifespan, with special emphasis on midlife and the menopausal transition and implications for treatment.

Migraine and sleep quality: does the association change in midlife women?

“…Women are more susceptible to migraine during the menopause transition due to the unpredictable drops in estradiol levels associated with depletion of ovarian follicles and decreasing ovarian function. 4,5 Indeed, women with a history of migraine have been found to have a…”

“…more rapid decline in estrogen levels during menopause transition than women without a history of migraine. 5,29 Women in perimenopause also often experience poor sleep quality. 7,9,[30][31][32] Low estradiol levels and rising follicle stimulating hormone levels have been associated with an increased risk of frequent awakenings, with a greater rate of change in follicle stimulating hormone levels predicting poorer sleep during the menopausal transition.…”

“…3,4 Similarly, women may experience an increase in migraine frequency around the menopause transition when estradiol levels are more variable and then a decrease in migraine frequency after menopause, when estradiol levels are stable and low. 1,[3][4][5] Poor sleep results in an annual economic burden of approximately $411 billion in the United States. 6 The prevalence of poor sleep quality is higher among women compared with men and increases significantly after the age of 50 to 55 years.…”

Urinary Proteomics Reveals Promising Biomarkers in Menstrually Related and Post-Menopause Migraine

“…In Table 2 are listed all the identified proteins with their entry name, primary full name, accession number, gene name (from the UniProt database), mass data, namely summary score, significant peptides, and significant sequences, and emPAI, the change in expression among the three groups (up-or down-regulation) and the main biological/molecular functions. (1) only in MM vs. both CTRL and PM, (2) only in PM vs both CTRL and MM, (3) in both MM and PM vs CTRL. (h) Main molecular function/ biological process.…”

“…Menstrually related migraine (MM) is a subclass of migraine that affects 42–61% of women with migraine disease [ 1 ]. Menstrual attacks are often much more disabling, of longer duration, and more resistant to treatment than migraine attacks occurring outside the perimenstrual period [ 2 , 3 ]. For millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social wellness.…”