Migraine and the menopause transition
Abstract
WHAT IS THE EFFECT OF MIGRAINE IN MIDLIFE WOMEN? Migraine is a neurologic disorder affecting approximately 42 million people in the United States, with women being three times more likely to experience migraine than men.1 This higher incidence in women is thought to arise from hormone fluctuations2—most notably the “estrogen drop” associated with the menstrual cycle—as well as possible neuroanatomic differences such as a thicker insular cortex in women. This sex-linked discrepancy remains incompletely understood. The peak prevalence of migraine coincides with the reproductive years. Many women, however, report changes in migraine characteristics and severity during perimenopause, with a significant number experiencing increased migraine frequency and intensity.3 A previously stable migraine pattern, triggered by hormone fluctuations in the menopause transition, may become erratic and more refractory to treatment. Phenotypic changes such as the development of migraine aura—including visual and sensory symptoms, sometimes without headache—can also arise during this stage. Although migraine prevalence begins to decline after age 60, approximately 50% of women affected in midlife continue to experience migraine postmenopause.2,3 WHAT IS MIGRAINE VERSUS MIGRAINE WITH AURA? Migraine, a chronic neurologic disorder, is characterized by recurrent attacks of moderate to severe headache lasting 4 to 72 hours, typically accompanied by nausea, vomiting, photophobia, and phonophobia.4 A…
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