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Migraine and the menopausal transition

Abstract

The menopausal transition or “perimenopause” represents a time period of turbulent changes in ovarian hormones as middle-aged women progress into menopause. The purpose of this article is to review the literature to determine the effect of the menopausal transition on migraine headaches and to develop a rational treatment approach to these patients. The menopausal transition is divided into early and stages based upon patterns of menstruation and specific reproductive hormones. Studies would suggest that the prevalence of migraine and other climacteric symptoms tend to peak during the late menopausal transition particularly in those with a past history of premenstrual stress disorder. Treatment approaches vary by stage of the menopausal transition and include conventional daily preventatives, mini-prophylaxis and hormonal therapies.

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References

  1. 1.

    Soules MR, Sherman S, Parrott E et al (2001) Executive summary: stages of reproductive aging workshop. Fertil Steril 76:874–878

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Harlow SD, Gass M, Hall JE et al (2012) Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab 97:1159–1168

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  3. 3.

    McKinlay SM, Brambilla DJ, Posner JG (1992) The normal menopause transition. Maturitas 14:103–115

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Luoto R, Kaprio J, Uutela A (1994) Age at natural menopause and sociodemographic status in Finland. Am J Epidemiol 139:64–76

    CAS  PubMed  Google Scholar 

  5. 5.

    Magursky V, Mesko M, Sokolik L (1975) Age at the menopause and onset of the climacteric in women of Martin District, Czechoslovakia: statistical survey and some biological and social correlations. Int J Fertil 20:17–23

    CAS  PubMed  Google Scholar 

  6. 6.

    Stanford JL, Hartge P, Brinton LA, Hoover RN, Brookmeyer R (1987) Factors influencing the age at natural menopause. J Chronic Dis 40:995–1002

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Gold EB, Bromberger J, Crawford S et al (2001) Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 153:865–874

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Rodstrom K, Bengtsson C, Milsom I, Lissner L, Sundh V, Bjourkelund C (2003) Evidence for a secular trend in menopausal age: a population study of women in Gothenburg. Menopause 10:538–543

    PubMed  Article  Google Scholar 

  9. 9.

    Gold EB, Crawford SL, Avis NE et al (2013) Factors related to age at natural menopause: longitudinal analyses from SWAN. Am J Epidemiol 178:70–83

    PubMed  Article  Google Scholar 

  10. 10.

    He C, Kraft P, Chen C et al (2009) Genome-wide association studies identify loci associated with age at menarche and age at natural menopause. Nat Genet 41:724–728

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. 11.

    Santoro N, Brown JR, Adel T, Skurnick JH (1996) Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab 81:1495–1501

    CAS  PubMed  Google Scholar 

  12. 12.

    Landgren BM, Collins A, Csemiczky G, Burger HG, Baksheev L, Robertson DM (2004) Menopause transition: annual changes in serum hormonal patterns over the menstrual cycle in women during a nine-year period prior to menopause. J Clin Endocrinol Metab 89:2763–2769

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Hale GE, Hughes CL, Burger HG, Robertson DM, Fraser IS (2009) Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause 16:50–59

    PubMed  Article  Google Scholar 

  14. 14.

    Freeman EW, Sammel MD, Lin H, Gracia CR, Kapoor S (2008) Symptoms in the menopausal transition: hormone and behavioral correlates. Obstet Gynecol 111:127–136

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Sabia S, Fourneir A, Mesrine S, Boutron-Ruault M, Clavel-Chapelon F (2008) Risk factors for onset of menopausal symptoms. Maturitas 60:108–121

    PubMed  Article  Google Scholar 

  16. 16.

    Bromberger JT, Kravitz HM, Chang YF, Cyranowski JM, Brown C, Matthews KA (2011) Major depression during and after the menopausal transition: study of women’s health across the nation. Psychol Med 41:1879–1888

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Bromberger JT, Kravitz HM, Chang Y et al (2013) Does risk for anxiety increase during the menopausal transition? study of women’s health across the nation. Menopause 20:488–495

    PubMed Central  PubMed  Google Scholar 

  18. 18.

    Kravitz HM, Zhao X, Bromberger JT et al (2008) Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep 31:979–990

    PubMed Central  PubMed  Google Scholar 

  19. 19.

    Randolph JF Jr, Sowers M, Bondarenko I et al (2005) The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab 90:6106–6112

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Ryan J, Burger HG, Szoeke C et al (2009) A prospective study of the association between endogenous hormones and depressive symptoms in postmenopausal women. Menopause 16:509–517

    PubMed Central  PubMed  Article  Google Scholar 

  21. 21.

    Freeman EW, Sammel MD, Lin H, Nelson DB (2006) Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 63:375–382

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Bromberger JT, Schott LL, Kravitz HM et al (2010) Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the study of women’s health across the nation. Arch Gen Psychiatry 67:598–607

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  23. 23.

    Kravitz HM, Janssen I, Santoro N et al (2005) Relationship of day-to-day reproductive hormone levels to sleep in midlife women. Arch Intern Med 165:2370–2376

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Wang SJ, Fuh JL, Lu SR, Juang KD, Wang PH (2003) Migraine prevalence during menopausal transition. Headache 43:470–478

    PubMed  Article  Google Scholar 

  25. 25.

    MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A (2006) Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology 67:2159–2163

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A (2006) Incidence of migraine relative to menstrual cycle phases of rising and falling estrogen. Neurology 67:2154–2158

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Martin VT, Behbehani M (2006) Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis–part 2. Headache 46:365–386

    PubMed  Article  Google Scholar 

  28. 28.

    Martin V, Wernke S, Mandell K et al (2003) Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache. Headache 43:309–321

    PubMed  Article  Google Scholar 

  29. 29.

    Johannes CB, Linet MS, Stewart WF, Celentano DD, Lipton RB, Szklo M (1995) Relationship of headache to phase of the menstrual cycle among young women: a daily diary study. Neurology 45:1076–1082

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Kiesner J, Martin VT (2013) Mid-cycle headaches and their relationship to different patterns of premenstrual stress symptoms. Headache 53:935–946

    PubMed  Article  Google Scholar 

  31. 31.

    Martin V, Wernke S, Mandell K et al (2005) Defining the relationship between ovarian hormones and migraine headache. Headache 45:1190–1201

    PubMed  Article  Google Scholar 

  32. 32.

    Odegard SS, Sand T, Engstrom M, Stovner LJ, Zwart JA, Hagen K (2011) The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache 51:570–580

    PubMed  Article  Google Scholar 

  33. 33.

    Allais G, Sanchez del Rio M, Diener HC et al (2011) Perimenstrual migraines and their response to preventive therapy with topiramate. Cephalalgia 31:152–160

    PubMed  Article  Google Scholar 

  34. 34.

    Toulis KA, Tzellos T, Kouvelas D, Goulis DG (2009) Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther 31:221–235

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Loprinzi CL, Sloan JA, Perez EA et al (2002) Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 20:1578–1583

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Carpenter JS, Storniolo AM, Johns S et al (2007) Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. Oncologist 12:124–135

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Silberstein SD, Elkind AH, Schreiber C, Keywood C (2004) A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology 63:261–269

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    de Lignieres B, Vincens M, Mauvais-Jarvis P, Mas JL, Touboul PJ, Bousser MG (1986) Prevention of menstrual migraine by percutaneous oestradiol. Br Med J (Clin Res Ed) 293:1540

    Article  Google Scholar 

  39. 39.

    Sulak P, Willis S, Kuehl T, Coffee A, Clark J (2007) Headache and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 47:27–37

    PubMed  Google Scholar 

  40. 40.

    Calhoun A, Ford S (2008) Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse. Headache 48(8):1186–1193

    PubMed  Article  Google Scholar 

  41. 41.

    Facchinetti F, Nappi RE, Tirelli A, Polatti F, Nappi G, Sances G (2002) Hormone supplementation differently affects migraine in postmenopausal women. Headache 42:924–929

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Misakian A, Langer R, Benseor I, Cook N, Manson J, Buring J, Rexrode K (2003) Postmenopausal hormone therapy and migraine headache. J Womens Health 12:1027–1036

    Article  Google Scholar 

  43. 43.

    Aegidius K, Zwart J, Hagen K, Schei B, Stovner L (2007) Hormone replacement therapy and headache prevalence in postmenopausal women: the head-hunt study. Eur J Neurol 14:73–78

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Nappi R, Cagnacci A, Granella F, Piccinini F, Polatti F, Facchinetti F (2001) Course of primary headaches during hormone replacement therapy. Maturitas 38:157–163

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Nappi RE, Sances G, Sommacal A et al (2006) Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches. Menopause 13:818–825

    PubMed  Article  Google Scholar 

  46. 46.

    Nappi R, Sances G, Detaddei S, Ornati A, Chiovato L, Polatti F (2009) Hormonal management of migraine at menopause. Menopause Int 15:82–88

    PubMed  Article  Google Scholar 

  47. 47.

    MacGregor A (1999) Estrogen replacement and migraine aura. Headache 39:674–678

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Mousa G (1982) Migraine and oral contraceptives. Am J Optom Physiol 59:821–823

    CAS  Article  Google Scholar 

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Correspondence to Vincent T. Martin.

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Martin, V.T. Migraine and the menopausal transition. Neurol Sci 35, 65–69 (2014). https://doi.org/10.1007/s10072-014-1745-1

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Keywords

  • Migraine
  • Menopausal transition
  • Perimenopause
  • Menopause