Skip to main content

Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

Migraine during perimenopause

Migraine affects the female sex to a greater extent than the male, with a female:male ratio of 3:1. Hormonal fluctuations during the reproductive life may influence migraine occurrence and intensity, both in a positive or negative way. Many women experience migraine approaching menopause, but the trend of migraine symptoms may vary according to the different stages of the perimenopause. If a woman is already a migraineur subject, the attacks often worsen during both the early and late phases of menopausal transition, whereas an onset of migraine is quite rare[1]. According to some authors, women with premenstrual syndrome (PMS) before menopause have an increased prevalence of migraine in late menopausal transition, and a subsequent reduction of the attacks in postmenopause[2]. The presence of PMS can be considered one of the predictors of migraine trend during the menopausal transition, since women with PMS are more sensitive to hormonal fluctuations and more prone to develop moderate to severe menopausal symptoms[3]. Hormone replacement therapy (HRT) can be used during the late premenopausal phase and the first years of postmenopause in order to counteract climacteric symptoms[4]. The effect of HRT on migraine has been investigated, either in its role of provoking or preventing the attacks. HRT should be administered continuously, without intervals, to avoid sudden estrogen deprivation and the consequent possible onset of migraine[5]. Treatment with estradiol-based gels and transdermal patches is preferable to oral formulation as it maintains constant serum hormone levels. In contrast to guidelines on the use of estroprogestinic contraceptives, migraine with aura is not an absolute contraindication to HRT when the way of administration is topical with a low dose of natural estrogens. If the aura recurs or worsens, HRT should be in any case discontinued[6]. When the effect of tibolone versus continuous combined HRT regimen in migraine is compared, a significant reduction in the hours with pain-limiting daily activities and of the amount of analgesics intake can be observed, even if there is no reduction of the days with migraine[7]. Natural menopause is associated with a lower incidence of migraine as compared with surgical menopause[8]; data on migraine prevalence in relation to the type of surgical procedure are till now unclear and contradictory[9].

Conflict of interest

None to declare.

References

  1. 1.

    Allais G, Chiarle G, Bergandi F, Benedetto C: Migraine in perimenopausal women. Neurol Sci. 2015, 36 (Suppl 1): S79-S83.

    Article  Google Scholar 

  2. 2.

    Wang SJ, Fuh JL, Lu SR, Juang KD, Wang PH: Migraine prevalence during menopausal transition. Headache. 2003, 43: 470-478. 10.1046/j.1526-4610.2003.03092.x.

    Article  PubMed  Google Scholar 

  3. 3.

    Freeman EW, Sammuel MD, Lin H, Gracia CR, Kapoor S: Symptoms in the menopausal transition: hormone and behavioral correlates. Obstet Gynecol. 2008, 111: 127-136. 10.1097/01.AOG.0000295867.06184.b1.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    MacGregor EA: Effects of oral and transdermal estrogen replacement on migraine. Cephalalgia. 1999, 19: 124-5. 10.1046/j.1468-2982.1999.019002124.x.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A: Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology. 2006, 67: 2159-2163. 10.1212/01.wnl.0000249114.52802.55.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    MacGregor EA: Perimenopausal migraine in women with vasomotor symptoms. Maturitas. 2012, 71: 79-82. 10.1016/j.maturitas.2011.11.001.

    Article  PubMed  Google Scholar 

  7. 7.

    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, 13: 818-825. 10.1097/01.gme.0000227399.53192.f5.

    Article  PubMed  Google Scholar 

  8. 8.

    Neri I, Granella F, Nappi R, Manzoni GC, Facchinetti F, Genazzani AR: Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas. 1993, 17: 31-37. 10.1016/0378-5122(93)90121-W.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Oldenhave A, Jaszmann LJ, Everaerd WT, Haspels AA: Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol. 1993, 168 (3 Pt 1): 765-771.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Giovanni Battista Allais.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Battista Allais, G., Chiarle, G., Bergandi, F. et al. Migraine during perimenopause. J Headache Pain 16, A25 (2015). https://doi.org/10.1186/1129-2377-16-S1-A25

Download citation

Keywords

  • Migraine
  • Hormone Replacement Therapy
  • Migraine With Aura
  • Tibolone
  • Premenstrual Syndrome