The impact of midlife on migraine in women: summary of current views
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REVIEW
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The impact of midlife on migraine in women: summary of current views Jelena M. Pavlović1,2
Abstract Migraine is three times more common in women than in men and is the 4th leading cause of disability in women. Onset of migraine increases at menarche, with peaks in prevalence in the late 30s, and a rapid decline after menopause. While the prevalence is highest among women of childbearing age the frequency of headache and burden of migraine frequently worsens during midlife. Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. The midlife worsening of migraine is attributed to hormonal fluctuations characteristic of the menopausal transition. Drops in estrogen presumably lead to increased migraine attacks at the time of menses as well as during the menopausal transition. During the menopausal transition, recommended approaches include both acute and preventive non-hormonal and hormonal options as well as behavioral approaches. Herein, is a brief review on the presentation of migraine in women across the lifespan, with special emphasis on midlife and the menopausal transition and implications for treatment. Migraine is a complex central nervous system disorder which is primarily characterized by headaches of long duration, with moderate to severe pain and associated symptoms such as light and sound sensitivity (photo- and phonophobia), nausea and vomiting [1]. More than “just a headache” it is a disorder of central nervous system dysregulation [2], that is three times more prevalent among women than men, with a cumulative lifetime prevalence among women of 43% [3]. It has long been recognized that migraine in women fluctuates with both monthly and life-stage dependent natural hormonal changes [4–6]. Though the peak prevalence of migraine occurs during the childbearing years, migraine symptomatology often worsens in midlife due to the hormonal fluctuations of the menopause transition, often with an increase in the number of headache days per month [7, 8]. This increase in migraine burden combined with the peak prevalence of migraine in the 4th and 5th decades of life, make migraine disease a major source of Correspondence: [email protected] 1 Albert Einstein College of Medicine, Department of Neurology, 1225 Morris Park Avenue, Van Etten 3C9B, Bronx, NY 10461, USA 2 Montefiore Medical Center/Montefiore Headache Center, 1250 Waters place, 8th floor, Bronx, NY 10461, USA
pain in midlife women. Although the increased burden of migraine among middle aged women has long been recognized in clinical practice, the epidemiology of migraine as women traverse midlife has been largely unexplored [9–11]. While there are abundant data on migraine during women’s reproductive years, there has been a paucity of studies focusing on migraine across the menopausal transition. Clinical practice has long held the notion that migraine improves in menopause, and this has been supported by the epidemiological studies which show migraine prevalence pea
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