Migraines and women

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Menstruation and Risk of Migraines

J. Larry on

[Copyright © 1998, 1999, 2000, 2001 by The McGraw-Hill Companies, Inc.

Reproduced with permission of The McGraw-Hill Companies.]

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Migraine headaches occur more frequently in women than in men. Although the

pathophysiology of migraines is debated, there is evidence for genetic

susceptibility as well as environmental triggers, which may include missed

meals, too little sleep, flashing lights, and stress. For some women,

hormonal events seem to be an important trigger. There is growing evidence

that a subset of women experience migraine headaches related to onset of

menses, although the nature of the hormonal changes and how they alter the

migraine threshold are not well understood.

A recent study by and colleagues (2000) found that women who suffer

from migraines are twice as likely to have one during the first 2 days of

their menstrual period than during the rest of the month. The association

with menses was stronger for migraines without aura than for those with

aura. Based on measures of headache severity, which included pain intensity,

duration of attack, symptom score, and disability score by headache type,

the " menstrual migraines " were not worse than those occurring at other times

of the month. These findings suggest that while hormone fluctuations may

alter the risk of attacks, they do not alter the characteristics of the

attack.

The fall in estrogen and/or progesterone in the late luteal phase of the

menstrual cycle may be a trigger for migraines occurring at the onset of

menses. Proposed mechanisms have included estrogen effects on vascular

responsiveness and/or effects of premenstrual fluid retention. However,

controlled studies have yet to demonstrate that hormonal intervention alters

the frequency or severity of headaches. It may be useful, however, to

document (using a diary) whether migraines occur consistently at the onset

of menses as this may help guide prophylactic management using standard

therapies. Future studies investigating the relationship of hormonal changes

and the occurrence of migraines may help clarify the pathophysiology of this

condition.

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References

WF et al: Menstrual cycle and headache in a population sample of

migraineurs. Neurology 55:1517, 2000 [PMID 20547736]

MacGregor EA : Menstruation, sex hormones, and migraine. Neurologic Clinics

15:125, 1997 [PMID 97211403]

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