Highlights
- •During the reproductive years menstrual migraine affects around 4–8% of all women and around 20–25% of women with migraine.
- •Migraine frequency and severity increase during perimenopause, particularly in women with menstrual migraine.
- •Perimenstrual estrogen ‘withdrawal’ is implicated in the pathophysiology of menstrual migraine, with increased prevalence of migraine in perimenopause associated with unpredictable estrogen fluctuations.
- •Symptomatic treatment of migraine is the same irrespective of whether or not attacks are associated with menstruation, and national or international guidelines should be followed.
- •Choice of preventive treatment depends on regularity of menstruation, presence or absence of menstrual disorders, presence or absence of vasomotor symptoms, sleep disturbance or depression, need for contraception, as well as a woman’s personal preferences.
- •Women needing contraception may benefit from continuous hormonal contraception. In women with migraine considering menopausal hormone therapy, transdermal estrogen together with progesterone is preferred. If hormone therapy is contraindicated, non-hormonal medication and lifestyle changes can benefit both conditions.
- •After menopause, the prevalence of migraine without aura declines with increasing time from the last menstrual period.
Abstract
Migraine is affected by the changing hormone environment, with perimenopause associated
with increased migraine, particularly menstrual migraine. Menstrual attacks are recognised
to be more disabling and less responsive to treatment compared with non-menstrual
attacks. Perimenstrual estrogen ‘withdrawal’ is implicated in the pathophysiology
of menstrual migraine, with increased prevalence of migraine in perimenopause associated
with unpredictable estrogen fluctuations. Perimenopausal women often have contraceptive
needs as well as menopause symptoms and it is important to understand the potential
effects of exogenous hormones on migraine. Maintaining stable estrogen levels with
exogenous hormones can benefit migraine but clinical trial data are limited. This
short narrative review addresses the diagnosis and management of menstrual migraine
in perimenopausal women, and discusses the management of menopause symptoms in peri-
and postmenopausal women with migraine.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2018; 17: 954-976
- The international classification of headache disorders.Cephalalgia. 2018; 38 (3rd edition): 1-211
- A self-administered screener for migraine in primary care: the ID Migraine validation study.Neurology. 2003; 61: 375-382
- A nosographic analysis of the migraine aura in a general population.Brain. 1996; 119: 355-361
- The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity.Cephalalgia. 2003; 23: 519-527
- Symptoms in the menopausal transition: hormone and behavioral correlates.Obstet. Gynecol. 2008; 111: 127-136
Institute for Health Metrics and Evaluation G.B.D. 2017 © 2020 University of Washington.
- Migraine with aura and reproductive life events: a case control study.Cephalalgia. 2000; 20: 701-707
- Prospective analysis of factors related to migraine attacks: the PAMINA study.Cephalalgia. 2007; 27: 304-314
- Menstrual migraine.Lancet Neurol. 2020; (in press)
- Identifying menstrual migraine- improving the diagnostic criteria using a statistical method.J. Headache Pain. 2019; 20: 95
- Estrogen-withdrawal migraine. I. Duration of exposure required and attempted prophylaxis by premenstrual estrogen administration.Neurology. 1975; 25: 239-244
- Incidence of migraine relative to menstrual cycle phases of rising and falling estrogen.Neurology. 2006; 67: 2154-2158
- Cortical spreading depression and estrogen.Headache. 2007; 47: S79-85
- Gender aspects of CGRP in migraine.Cephalalgia. 2019; 39: 435-444
- Sequential classification of endocrine stages during reproductive aging in women: the FREEDOM study.Menopause. 2005; 12: 281-290
- Sex hormones in women with and without migraine: evidence of migraine-specific hormone profiles.Neurology. 2016; 87: 49-56
- TRP channels as potential targets for sex-related differences in migraine pain.Front. Mol. Biosci. 2018; 5: 73
- The role of progesterone in menstrual migraine.Neurology. 1971; 21: 853-859
- Oestrogen and attacks of migraine with and without aura.Lancet Neurol. 2004; 3: 354-361
- Serum levels of androgens and migraine in postmenopausal women.Clin. Sci. 2002; 103: 487-491
- Eicosanoids in primary dysmenorrhea, endometriosis and menstrual migraine.Gynecol. Endocrinol. 1989; 3: 71-94
- Menstrual-related pain conditions: dysmenorrhea and migraine.J. Womens Health (Larchmt.). 2008; 17: 879-891
- Migraine in menopausal women: a systematic review.Int. J. Womens Health. 2015; 7: 773-782
- Hormonal factors in migraine: a population-based study of women aged 40 to 74 years.Headache. 2003; 43: 27-35
- Migraine prevalence during menopausal transition.Headache. 2003; 43: 470-478
- Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the american migraine prevalence and prevention study.Headache. 2016; 56: 292-305
- Longitudinal course of vasomotor symptoms in perimenopausal migraineurs.Ann. Neurol. 2019; 85: 865-874
- Risk factors for onset of menopausal symptoms Results from a large cohort study.Maturitas. 2008; 60: 108-121
- The bidirectional relationship between vasomotor symptoms and depression across the menopausal transition: a systematic review of longitudinal studies.Menopause. 2018; 25: 109-120
- Sleep disorders among people with migraine: results from the chronic migraine epidemiology and outcomes (CaMEO) study.Headache. 2019; 59: 32-45
- Migraine with aura: a review of 81 patients at 10-20 years’ follow-up.Cephalalgia. 1998; 18: 690-696
- New international classification of migraine with aura (ICHD-2) applied to 362 migraine patients.Eur. J. Neurol. 2004; 11: 583-591
- Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age.Am. J. Obstet. Gynecol. 1993; 168: 765-771
- Menstrual migraine.Lancet Neurol. 2020; (In press)
- Perimenstrual migraines and their response to preventive therapy with topiramate.Cephalalgia. 2011; 31: 152-160
- Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH).J. Headache Pain. 2018; 19: 76
- The 7-day contraceptive hormone-free interval should be consigned to history.BMJ Sex Reprod. Health. 2018;
- Migraine and ischemic stroke in women. A narrative review.Headache. 2020; 60: 843-863
- Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC).J. Headache Pain. 2017; 18: 108
- Effectiveness of the progestin-only pill for migraine treatment in women: a systematic review and meta-analysis.Cephalalgia. 2018; 38: 754-764
- Effect of desogestrel 75 microg on headache frequency and intensity in women with migraine: a prospective controlled trial.Eur. J. Contracept. Reprod. Health Care. 2019; 24: 175-181
- Predictability of exogenous hormone effect on subgroups of migraineurs.Headache. 2000; 40: 189-193
- Postmenopausal hormone therapy and migraine headache.J. Womens Health (Larchmt.). 2003; 12: 1027-1036
- Hormone replacement therapy and headache prevalence in postmenopausal women. The Head-HUNT study.Eur. J. Neurol. 2007; 14: 73-78
- Course of primary headaches during hormone replacement therapy.Maturitas. 2001; 38: 157-163
- Hormone supplementation differently affects migraine in postmenopausal women.Headache. 2002; 42: 924-929
- Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura.J. Headache Pain. 2014; 15: 30
- Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches.Menopause. 2006; 13: 818-825
- Short-term and long-term effects of tibolone in postmenopausal women.Cochrane Database Syst. Rev. 2016; 10CD008536
- Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache.Headache. 2003; 43: 309-321
- Allopregnanolone and progesterone in experimental neuropathic pain: former and new insights with a translational perspective.Cell. Mol. Neurobiol. 2019; 39: 523-537
- Postmenopausal hormone therapy and risk of stroke: impact of the route of estrogen administration and type of progestogen.Stroke. 2016; 47: 1734-1741
Article info
Publication history
Published online: July 09, 2020
Accepted:
July 8,
2020
Received in revised form:
July 1,
2020
Received:
June 1,
2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier B.V. All rights reserved.
