A team of researchers reporting at the 56th Annual Scientific Meeting of the American Headache Society found that migraine attack frequency is higher in women during peri-menopause and menopause than in pre-menopause. During pre-menopause, periods are typically regular. During the menopausal transition or "peri-menopause" menstrual periods become irregular and at menopause, menstrual periods stop.
"Ours is the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition," said first author Vincent T. Martin, M.D., Co-director of the University of Cincinnati Headache and Facial Pain Program and Professor of Medicine in the Department of Internal Medicine, University of Cincinnati.
The research was conducted as part of the American Migraine Prevalence and Prevention (AMPP) Study, a longitudinal mailed questionnaire survey of 120,000 US households selected to be representative of the US population. Using data from the 2006 AMPP Study survey, women with migraine aged 35-65 years of age were eligible for these analyses. Women with migraine were classified based on headache frequency into a high frequency group if they experienced 10 or more headache days per month and into a low or moderate frequency episodic migraine group if they had less than 10 days per month. Women were also classified as premenopausal, peri-menopausal or postmenopausal (absent menstrual periods for at least 12 months) based upon responses to the questionnaire.
Of 3,603 eligible women, the mean age was 45 and 34% were premenopausal, 35% were peri-menopausal and 30% were menopausal. Frequent headache (10 or more days per month) was 50 to 60% more common among peri-menopausal (12.2%) and menopausal women (12.0%) compared with the pre-menopausal group (8.0%).
"Given that migraines tend to worsen during menstruation, it may seem paradoxical that when periods become irregular during the peri-menopause or absent during menopause that headache become more frequent," said Richard B. Lipton, M.D., professor of Neurology and director of the Montefiore Headache Center at the Albert Einstein College of Medicine. "We believe that both declining estrogen levels that occur at the time of menstruation as well as low estrogen levels that are encountered during the menopause are triggers of migraine in some women," he said.
"These results validate the belief by many women that their headaches worsen during the transition into menopause," Dr. Martin said. "We hope that our work spurs researchers to develop novel treatments for migraine during this time period given that many of the headaches encountered are thought to be hormonally triggered."
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