Migraines at menopause

Hormones and migraines

Changes in hormone levels occur throughout the course of a woman’s life, associated with the onset of menstruation, oral contraceptive use, pregnancy, breastfeeding, and menopause. These hormone level changes frequently are accompanied by changes in the patterns and frequency of migraines. The sexual hormones, primarily estrogen and progesterone, often play a key role in the occurrence and frequency of migraine headaches in women who suffer from them. Therefore, it is not surprising that the most common time that migraine headaches first begin in women is between the ages of 12 and 13, which often coincides with the beginning of menstruation. Some women experience their migraines with regularity, either in the time before, after, or during their menstrual period. For women who experience migraine headaches, 60% of them have their headaches worsen around the time of their menstrual period.

Menopause and migraines

The transition from the childbearing years to natural menopause usually occurs over approximately 4 years, beginning around the age of 50. Women who suffer from migraine and have gone through menopause may notice changes in their headaches, especially their frequency. Many women with migraine have a worsening of symptoms due to fluctuating estrogen levels as they enter perimenopause, the period preceding and leading into menopause. Among women who undergo spontaneous or natural menopause, 67% have a general improvement in their headache symptoms and frequency after menopause. Some women undergo what’s called surgical menopause, which is usually a result of the removal of their ovaries, and only 33% of these women experience improvement in their migraine symptoms, and for some, migraine symptoms worsen.

Hormone replacement therapy (HRT) and migraines

Some women may need to take hormone replacement therapy (HRT) after going through natural or surgical menopause. The main therapeutic value of HRT in women is the ability to treat troubling symptoms of menopause. These include hot flashes, difficulty concentrating, headaches, altered libido, depression, anxiety, and to prevent osteoporosis. Since it is well known that sexual hormones play a key role in the occurrence and patterns of migraine in women, it makes sense to consider the impact of using HRT in people suffering from migraines. Some women may experience improvement of their headache symptoms with hormone replacement, but others may have worsening symptoms. The frequent use of HRT in surgical menopause may be responsible for the lower rate of migraine improvement in those women, as HRT may be responsible for that. HRT may be very useful however, in managing headaches during the initial hormonal changes of perimenopause during the menopausal transition.

The use of HRT in menopausal women is currently a controversial topic. HRT has come under fire in recent years, particularly after the results of a large study performed by the National Institute of Health called the Women’s Health Initiative. In 2002-03, this long-term research study of hormone replacement therapy in postmenopausal women reported that the risks of HRT may outweigh the benefits. There is some evidence that shows that in the event that HRT is necessary, reducing the estrogen dose and changing the estrogen type or the route of administration from oral to transdermal (skin patch), may reduce the occurrence of migraines.

Alternative therapies for migraine after menopause

Estimates are that between 30% and 60% of women use some type of alternative interventions for the symptoms of menopause, including “natural” estrogens, plant estrogens, herbal medicines, and acupuncture. Botanicals, herbals, and many steroid products are sold over the counter, and some do exert significant hormonal activity. Phytoestrogens are a class of plant-derived estrogen-like compounds that can be taken orally. They are of particular interest because of the possibility that this herb may have positive benefits for post-menopausal migraineurs.

Women with migraines may undergo changes in headache symptoms during perimenopause and post-menopause. All of the standard medical and non-medical approaches to treating your migraines still apply after menopause. Be sure to ask your physician for more information about all available options, such as the FDA status of any medication choice, so that you and your doctor can decide which treatment is best for you.

References

Katz, V.L. (2007). Comprehensive gynecology: 5th ed. St. Louis, MO: Mosby.

Marcus, D.A. (1999). Focus on primary care: diagnosis and management of headache in women. Obstetrical & Gynecological Survey. 54 (6), 395-402.

Silberstein, S., & Merriam, G. (1999). Sex hormones and headache. Neurology. 53(4), S3-S13.