The Impact of Middle Age on Migraine in Women: A Summary of Current Opinion
Migraine is three times more common in women than in men and is the fourth leading cause of disability in women. The incidence of migraine increases with menarche, with prevalence peaking in the late 30s and declining rapidly after menopause. Prevalence is highest among women of childbearing age, but headache frequency and migraine burden are often worse during middle age. Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. Midlife exacerbation of migraine is attributed to the hormonal fluctuations characteristic of the menopausal transition. Decreased estrogen levels probably lead to increased migraine attacks during menstruation and the menopausal transition. During the menopausal transition, recommended approaches include both behavioral approaches as well as acute and prophylactic non-hormonal and hormonal options. Here is a brief review of migraine symptoms in women across the lifespan, with particular emphasis on the midlife and menopausal transition and its impact on treatment.
Pavlović, JM The impact of midlife on migraine in women: a summary of current views. Midlife Health Womens 6, 11 (2020). https://doi.org/10.1186/s40695-020-00059-8
Commentary
Migraine in women is greatly influenced by fluctuations in female sex hormone levels, which change during menstruation and menopause, and in general, migraine tends to improve with the onset of menopause. However, during the peri-menopausal period, it is thought that fluctuations in estrogen levels may be responsible for the frequency and significant worsening of migraine headaches. However, due to the lack of studies focusing on migraine and sex hormone changes, the mechanisms of peri-menopausal and menstrual migraine seem to remain unclear.
Therefore, it is necessary to deepen our understanding of the exogenous and endogenous causes of migraine, as a better understanding of these relationships will be important for clinical symptoms and treatment.
