Menopause & Migraine Headaches
Among women who have migraines, fluctuating hormone levels during menopause may mean a decrease in migraine intensity and frequency, but they could also mean worsening of headaches. The most effective therapies for menopausal migraines are those used for migraines due to other causes. Treatments for menopausal symptoms, such as hormone replacement therapy or black cohosh, may actually worsen migraine in some women.
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Migraine
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A migraine produces severe throbbing pain usually on one side of the head. The headache is typically accompanied by nausea, vomiting and sensitivity to light or sound and lasts from four to 72 hours Migraines are caused by a series of vascular changes in the brain. A trigger, such as certain foods, stress or lack of sleep, cause blood vessels in the brain to constrict. Other blood vessels overcompensate and dilate to increase the blood supply to the brain. The dilated blood vessels press against nearby nerves, causing the debilitating pain.
Menopause
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Menopause is defined as the period of a woman's life after menses has ceased for a complete year; perimenopause is the period before the permanent end of menses when hormone levels are decreasing. During perimenopause, women often experience symptoms such as hot flashes, mood swings and, for some women, migraines.
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Hormones and Migraine
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Monthly hormonal fluctuations trigger migraines in some women. The female hormones estrogen and progestin affect brain neurotransmitter levels, which triggers migraines. Additionally, falling estrogen levels change levels of proteins that moderate pain, increasing sensitivity to headaches. The unpredictable hormonal fluctuations during perimenopause alter the migraine pattern in some women, either increasing or decreasing frequency and severity. About 66 percent of women experience an improvement in migraines after menopause, whereas migraines will worsen in 10 percent and the rest have no change, according to Dr. Michael P. Goodman, author of The Midlife Bible -- A Woman's Survival Guide. Women who have always had migraines around the time of their monthly period tend to be more sensitive to hormonal changes and are most affected by fluctuating estrogen levels during perimenopause. Interestingly, worsening migraines during perimenopause is unrelated to an increased incidence of other menopause symptoms, according to Dr. Lynne O. Geweke. Geweke is clinical assistant professor and director of the Headache Clinic at the University of Iowa, Iowa City. Hormonal-related migraines tend to be less severe after natural menopause compared with menopause induced by hysterectomy.
Hormone Replacement Therapy
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Hormone replacement therapy (HRT) relieves menopause symptoms but it is should not be the first choice for migraine treatment, according to Geweke. HRT is associated with an increase in cardiac side effects and may cause an increased risk of breast cancer. Furthermore, migraines are reported more frequently among women using HRT than in those not using HRT. If HRT is prescribed, transdermal preparations (either skin patch or cream) deliver a continuous dose, compared with fluctuating estrogen levels administered in oral preparations.
Nonhormonal Migraine Treatments
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Triptans (sumatriptan, zolmitriptam, rizatriptan, eletriptan and naratriptan) effectively treat menopause-related migraine as well as migraines unrelated to hormones. Lifestyle changes, such as eating regular meals and avoiding foods known to trigger migraine, have little effect on menopausal migraine. Natural menopause relief products, for example black cohosh and soy, have weak estrogenic activity and may trigger migraine in some women.
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