At this year’s Annual Scientific Meeting of the American Headache Society a group of researchers presented their findings that migraine frequency may be reduced after menopause. That’s the good news. However, like all good research, the rest of the story gets complicated. It turns out that the years between pre-menopause and menopause can be some of the hardest on migraineurs. The perimenopausal years often start in a woman’s 40s and continue until menopause occurs around age 51. These years are characterized by fluctuating hormone levels, irregular periods, sleep disturbances, hot flashes, mood swings, and unfortunately, an increase in migraines. The increased migraine frequency may occur because of an increase in trigeminal nerve sensitivity to falling estrogen levels.
Some might take this as a sign that a short-cut through this unpleasant cycle by getting a hysterectomy is in order. Once again, things are not as they seem. Research from 2011 determined that women who go through perimenopause naturally have a better chance of seeing their migraines reduced post-menopause while those who opt for a hysterectomy tend to continue the trend of frequent migraine. Both results are conditional though, depending greatly on whether or not a woman’s migraines earlier in life were closely related to her menstruation. If a woman experienced menstrual migraine or menstrually-related migraine as her most severe migraine each month, then the results of this study might apply. However, if her worst migraines occurred as a result of non-hormonal factors, the transition into menopause may have no effect.
Confused? I certainly was. It gets even more complicated. According to a June 2009 article published in Post Reproductive Health, the recommended treatment for management of menstrual migraines in perimenopause is HRT. Yet according to Dr. Ralph Evans in Handbook of Headache, the use of HRT has a 45% of reducing the number of attacks and almost an equal chance (46%) of making them worse.
There are other alternatives you can discuss with your headache specialist though. Taking NSAIDs for three days prior to the start of menses and continuing through the cycle can sometimes prevent menstrual migraines. Others have success with using long-lasting triptans daily for the same duration. Magnesium supplementation may also be effective. If non-hormonal treatments fail, HRT may still be considered. The best hormone replacement results (33% improvement) appear to be from more natural forms of estrogen such as a patch while conjugated estrogens (Premarin) tend to make migraines worse. Given the odds, I think I’d prefer to try one of the non-hormonal options first.
Now that I am entering perimenopause, I have noticed the nastiest migraines tend to occur during the months when my cycle is most irregular. I’ve complained to my headache specialist. He put me on the waiting list for a cancellation so I can get in sooner than 3 months from now. Hopefully we’ll be able to find a good option that gets me through the next 5-7 years.
What have been your experiences with migraine and menopause?
Do you think the research is right?