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Chapter 7 - Migraine in the Menopause

Published online by Cambridge University Press:  18 June 2020

Nicholas Panay
Queen Charlotte's & Chelsea Hospital, London
Paula Briggs
Liverpool Women's NHS Foundation Trust
Gabor T. Kovacs
Monash University, Victoria
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Up to 43 per cent of women and 18 per cent of men are affected by migraine at some time in their lives [1]. This sex difference is accounted for by the influence of reproductive hormones in women, with notable effects of menarche, menstruation, pregnancy, lactation, menopause and hormonal contraception on migraine. In particular, the perimenopause is a time of worsening migraine [2–4]. Despite this, migraine is significantly under-reported by women seeking management of menopause who should routinely be asked about headache [4].

Publisher: Cambridge University Press
Print publication year: 2020

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Stewart, WF, Wood, C, Reed, ML, et al. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008;28(11):1170–8.CrossRefGoogle ScholarPubMed
Ripa, P, Ornello, R, Degan, D, et al. Migraine in menopausal women: a systematic review. Int J Women’s Health 2015;7:773–82.Google ScholarPubMed
Martin, VT, Pavlovic, J, Fanning, KM, et al. 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(2):292305.CrossRefGoogle ScholarPubMed
MacGregor, EA, Barnes, D. Migraine in a specialist menopause clinic. Climacteric 1999 Sep;2(3):218–23.CrossRefGoogle Scholar
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018 Jan;38(1):1211.CrossRefGoogle Scholar
Bille, B. A 40-year follow-up of school children with migraine. Cephalalgia 1997;17:488–91.CrossRefGoogle ScholarPubMed
Vos, T, Abajobir, AA, Abate, KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017 Sep 16;390(10100):1211–259.CrossRefGoogle Scholar
Steiner, TJ, Scher, AI, Stewart, WF, et al. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia 2003 Sep;23(7):519–27.CrossRefGoogle Scholar
Michel, P, Dartigues, JF, Henry, P, et al. Validity of the International Headache Society criteria for migraine. GRIM. Groupe de Recherche Interdisciplinaire sur la Migraine. Neuroepidemiology 1993;12(1):51–7.CrossRefGoogle Scholar
Schreiber, CP, Hutchinson, S, Webster, CJ, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed ‘sinus’ headache. Arch Intern Med 2004 Sep 13;164(16):1769–72.CrossRefGoogle ScholarPubMed
MacGregor, EA. Migraine management during menstruation and menopause. Continuum 2015 Aug;21(4):9901003.Google ScholarPubMed
Gowers, WR. Subjective sensations of sight and sound, abiotrophy, and other lectures. In: Lectures on Diseases of the Nervous System, 2nd series. 1904. J & A Churchill pp. 1841.Google Scholar
MacGregor, EA. Diagnosing migraine. J Family Plann Reprod Health Care 2016 Oct 1;42(4):280–6.Google ScholarPubMed
Russell, MB, Olesen, J. A nosographic analysis of the migraine aura in a general population. Brain 1996 Apr;119(Pt 2):355–61.CrossRefGoogle Scholar
Steiner, TJ, Jensen, R, Katsarava, Z, et al. Aids to management of headache disorders in primary care (2nd edition): on behalf of the European Headache Federation and Lifting the Burden: the Global Campaign against Headache. J Headache Pain 2019 May 21;20(1):57.CrossRefGoogle Scholar
Network SIG. Pharmacological management of migraine. SIGN Publ 155. 2018. Scholar
Sacco, S, Merki-Feld, GS, Aegidius, KL, et al. 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 Aug 31;19(1):76.CrossRefGoogle Scholar
Hale, GE, Hughes, CL, Burger, HG, et al. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause 2009 Jan–Feb;16(1):50–9.Google ScholarPubMed
Miro, F, Parker, SW, Aspinall, LJ, et al. Sequential classification of endocrine stages during reproductive aging in women: the FREEDOM study. Menopause 2005 May–Jun;12(3):281–90.Google ScholarPubMed
Su, HI, Freeman, EW. Hormone changes associated with the menopausal transition. Minerva Ginecol 2009 Dec;61(6):483–9.Google ScholarPubMed
Maleki, N, Cheng, YC, Tu, Y, et al. Longitudinal course of vasomotor symptoms in perimenopausal migraineurs. Ann Neurol 2019 Jun;85(6):865–74.CrossRefGoogle ScholarPubMed
MacGregor, EA. Oestrogen and attacks of migraine with and without aura. Lancet Neurol 2004 Jun;3(6):354–61.Google ScholarPubMed
Wang, SJ, Fuh, JL, Lu, SR, et al. Migraine prevalence during menopausal transition. Headache 2003 May;43(5):470–8.CrossRefGoogle ScholarPubMed
Nagel-Leiby, S, Welch, KM, Grunfeld, S, et al. Ovarian steroid levels in migraine with and without aura. Cephalalgia 1990;10(3):147–52.CrossRefGoogle ScholarPubMed
Mattsson, P. Serum levels of androgens and migraine in postmenopausal women. Clin Sci (Lond) 2002 Nov;103(5):487–91.CrossRefGoogle ScholarPubMed
MacGregor, EA. ‘Menstrual’ migraine: towards a definition. Cephalalgia 1996 Feb;16(1):1121.CrossRefGoogle Scholar
Cupini, LM, Matteis, M, Troisi, E, et al. Sex-hormone-related events in migrainous females: a clinical comparative study between migraine with aura and migraine without aura. Cephalalgia 1995 Apr;15(2):140–4.CrossRefGoogle ScholarPubMed
Neri, I, Granella, F, Nappi, R, et al. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993 Jul;17(1):31–7.CrossRefGoogle ScholarPubMed
Oldenhave, A, Jaszmann, LJ, Everaerd, WT, et al. Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol 1993 Mar; 168(3 Pt 1):765–71.CrossRefGoogle ScholarPubMed
Misakian, AL, Langer, RD, Bensenor, IM, et al. Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt) 2003 Dec;12(10):1027–36.CrossRefGoogle ScholarPubMed
Aegidius, KL, Zwart, JA, Hagen, K, et al. Hormone replacement therapy and headache prevalence in postmenopausal women: the Head-HUNT study. Eur J Neurol 2007 Jan;14(1):73–8.CrossRefGoogle ScholarPubMed
Nappi, RE, Sances, G, Sommacal, A, et al. Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches. Menopause 2006 Sep–Oct;13(5):818–25.Google ScholarPubMed
Facchinetti, F, Nappi, RE, Tirelli, A, et al. Hormone supplementation differently affects migraine in postmenopausal women. Headache 2002;42(9):924–9.CrossRefGoogle ScholarPubMed
Lichten, EM, Lichten, JB, Whitty, A, et al. The confirmation of a biochemical marker for women’s hormonal migraine: the depo-estradiol challenge test. Headache 1996 Jun;36(6):367–71.CrossRefGoogle ScholarPubMed
MacGregor, A. Effects of oral and transdermal estrogen replacement on migraine. Cephalalgia 1999;19:124–5.CrossRefGoogle ScholarPubMed
Nappi, RE, Cagnacci, A, Granella, F, et al. Course of primary headaches during hormone replacement therapy. Maturitas 2001 Apr 20;38(2):157–63.CrossRefGoogle ScholarPubMed
Kuhl, H. Pharmacokinetics of oestrogen and progestogens. Maturitas 1990;12:171–97.CrossRefGoogle ScholarPubMed
Kaiser, HJ, Meienberg, O. Deterioration or onset of migraine under oestrogen replacement therapy in the menopause. J Neurol 1993;240(3):195–6.CrossRefGoogle ScholarPubMed
MacGregor, A. Estrogen replacement and migraine aura. Headache 1999;39:674–8.CrossRefGoogle ScholarPubMed
Palacios, S, Mejia, A. Progestogen safety and tolerance in hormonal replacement therapy. Expert Opin Drug Saf 2016 Nov;15(11):1515–25.CrossRefGoogle ScholarPubMed
Moehlig, RC. Methyl testosterone for migraine of women; report of sixty cases. J Mich State Med Soc 1955 May;54(5):577–9.Google ScholarPubMed
Greenblatt, RB, Bruneteau, DW. Menopausal headaches – psychogenic or metabolic? J Am Geriatr Soc 1974 Apr;22(4):186–90.CrossRefGoogle ScholarPubMed
Glaser, R, Dimitrakakis, C, Trimble, N, et al. Testosterone pellet implants and migraine headaches: a pilot study. Maturitas 2012 Apr;71(4):385–8.CrossRefGoogle ScholarPubMed
Kurth, T, Chabriat, H, Bousser, MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol 2012 Jan;11(1):92100.CrossRefGoogle ScholarPubMed
Sacco, S, Merki-Feld, GS, Ægidius, KL, et al. 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 Oct 30;18(1):108.CrossRefGoogle Scholar
Peng, KP, Chen, YT, Fuh, JL, et al. Migraine and incidence of ischemic stroke: A nationwide population-based study. Cephalalgia 2017 Apr;37(4):327–35.CrossRefGoogle ScholarPubMed
Pavlovic, J, Hedlin, H, Yang, J, et al. The relationship between migraine, cardiovascular disease (CVD) and hormone therapy (HT) in postmenopausal women in the Women’s Health Initiative study (WHI) [abstract]. Menopause 2017;12:1429.Google Scholar
Li, L, Schulz, UG, Kuker, W, et al. Age-specific association of migraine with cryptogenic TIA and stroke: population-based study. Neurology 2015 Oct 27;85(17):1444–51.CrossRefGoogle ScholarPubMed
Stuenkel, CA, Davis, SR, Gompel, A, et al. Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2015 Nov;100(11):39754011.CrossRefGoogle Scholar
MacGregor, EA. Migraine, menopause and hormone replacement therapy. Post Reprod Health 2018 Mar;24(1):1118.CrossRefGoogle ScholarPubMed

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