“For years women have been telling me as a headache doctor that
their headaches worsen in perimenopause,” but it hadn’t been
directly studied, said lead author Dr. Vincent T. Martin of the
University of Cincinnati College of Medicine and co-director of the
Headache and Facial Pain Program at the UC Neuroscience Institute.
Symptoms like hot flashes, irritability, insomnia and depression may
start during the hormonal changes of perimenopause, when periods
become irregular, but menopause does not officially begin until
periods have stopped for one year.
“Since the average age of menopause is 51 to 52, and the average
transition is five to 10 years, women may see a worsening of their
migraines as early as 42 to 47 years old if they are going to have
an average-age menopause,” said North American Menopause Society
executive director Dr. JoAnn V. Pinkerton. “The variability for
normal menopause is 45 to 55, so women could see an intensification
before or after that time.”
Changes in brain chemicals may cause blood vessels to swell or
dilate, putting pressure on nearby nerves and structures and causing
a migraine, Pinkerton told Reuters Health by email.
“Hormonal fluctuations appear to act as triggers for migraines,
although the actual mechanism is not known,” said Pinkerton, who was
not part of the new study.
Martin and his coauthors used data from a 2006 survey of more than
3,000 women ages 35 to 65 who experienced migraines before and
during menopause and who self-reported headache symptoms and details
of their menstrual cycles.
About 8 percent of women who were still having regular periods
reported high-frequency migraines of more than 10 days per month.
That rate rose to more than 12 percent of those in perimenopause and
about 12 percent of postmenopausal women whose periods had stopped
altogether, as reported in Headache: The Journal of Head and Face
Risk of headache was highest during late perimenopause, before
periods stopped completely, when estrogen levels are low.
Women who have premenstrual symptoms earlier in life are likely to
be hormonally sensitive and have a higher risk for migraines later,
Martin told Reuters Health by phone.
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“Probably in perimenopausal women it’s strictly hormones, but in
menopausal women there was a huge uptake in medications to treat
headaches,” Martin said. “If you start using a lot of these pain
medications that might cause something called rebound headaches,
which may be different.”
Depression rates increase during menopause as well, and women who
are depressed may be more likely to report headaches as severe, he
During perimenopause, hormones can increase or decrease unexpectedly
as the ovaries are “sputtering,” he said.
“Every life event in a woman has the potential for changing
migraines, including her first period, pregnancy and perimenopause,”
If hormones are triggering headaches, they may be moderated with
birth control pills or a hormone estrogen patch, he said.
“Postmenopause, once hormonal fluctuations have diminished and
hormone levels are consistently low and stable, the migraines often
improve or stop,” Pinkerton said. “Hormone therapy given for hot
flashes may worsen or improve migraines.”
“Migraines are one of the most common causes of disability in the
workplace of any disease,” Martin said. “If your headaches are
occurring more than 15 days per month, if you’re using a lot of
medications, or if you’re not getting reasonable relief from the
treatments that your primary care physicians prescribe, then seek
out a pain specialist.”
SOURCE: http://bit.ly/1RGQZss Headache: The Journal of Head and Face
Pain, online January 21, 2016.
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