Here’s one piece of good news for women to look forward to: migraines may decrease or abate after menopause.
According to the American Migraine Foundation (AMF), a non-profit organization dedicated to the advancement of research and awareness surrounding migraine, more than 39 million men, women, and children in the United States are affected by migraines. However, women are two to three times more likely to have migraines than men.
Why Women Are More Likely to Suffer From Migraines
A study published in The Journal of Headache and Pain shows that female migraine sufferers usually begin having migraines after their first period. Migraines that are associated with menstruation often occur in the days just before or during a woman’s period due to a rapid drop in estrogen levels that occur immediately preceding menstruation.
During pregnancy, many women may also experience a decrease in or a break from migraines due to changes in estrogen levels. Later in life, as women transition into menopause, a percentage of women may find that they experience more frequent migraines due to fluctuations in estrogen and progesterone levels.
Dr. Michael Franklin, a neurologist at St. Anthony’s Hospital in Florida, states that perimenopause can bring about an increase in migraine severity and frequency. Dr. Franklin is board certified in neurology, electrodiagnostic medicine, and headache medicine.
“During perimenopause, migraines can become very difficult to control,” he said.
However, women who suffer from migraines may find relief after they complete menopause.
Hormones are only one cause of migraines. Certain triggers that can bring on a migraine include, but are not limited to:
- certain foods
- alcoholic beverages
- stress
- sleep disorders (oversleeping, lack of sleep, or change in sleep pattern)
- smells
- weather changes
“Twenty to 30 percent of people will have a migraine,” said Franklin.
Migraines in women may often present with an aura. An aura is an additional neurological symptom that occurs with, or sometimes before, the development of a migraine headache. Auras can also happen without the presence of a migraine. Migraines accompanied by auras are also known as complex or complicated migraines.
Migraine With Aura
Dr. David Dodick, a neurologist at the Mayo Clinic in Arizona, and president of the American Headache Society states that women are three times more likely to develop migraines with or without auras than men are. According to Dodlick, 30 percent of people experiencing a migraine will have symptoms of an aura.
These auras usually develop over five minutes and usually resolve within an hour; however, auras sometimes can persist for weeks.
Examples of auras include visual symptoms, such as seeing sparks, zig-zag lines, prisms, or having blind spots in their vision. Auras also include tingling or numbness that involves the face, the hands, or one side of the body. Language problems, specifically articulating words, and difficulty speaking, are other ways auras may be experienced.
Medication for Migraines
There are a variety of medications available for acute relief of migraine with aura. These medications work best when they are taken at the first sign of a migraine.
Common acute treatments include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, etc.). Other acute treatments include a class of drugs called triptans. Sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are two triptans that are widely prescribed. These medications may provide migraine relief; however, these drugs may not be safe for those who are at risk of a stroke or heart attack.
Prescription medications include lasmiditan (Reyvow), and CGRP antagonists, including urogepant (Ubrelvy) and rimegepant (Nurtec ODT), may also be used to treat acute migraines. Anti-nausea drugs may also be helpful for those with migraine.
Medication may also be prescribed as a preventative measure. These include blood pressure-lowering medications such as beta-blockers and calcium channel blockers. Amitriptyline, a tricyclic antidepressant, and anti-seizure medications such as valproate and topiramate (Topamax, Qudexy XR, and others) can also help prevent migraines.
CGRP monoclonal antibodies, such as erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti) are newer drug options and are also used to prevent migraines. These medications are given by injection quarterly or once a month.
Botox injections may also be helpful in preventing migraines.
Estrogen supplements can help prevent the drop in estrogen that often triggers a migraine attack. Supplementation can come in the form of a pill, vaginal gel, or patch.
Suppressing periods through long-acting birth control pills may be helpful to women who have migraines with menstruation, says Franklin.
However, physicians have differing opinions on whether birth control pills containing estrogen are safe for women suffering from migraine with aura, especially around the menopause-age range, as it may increase the risk of stroke in this population.
Dr. Mehyar Mehrizi, neurologist and Adjunct Clinical Associate Professor of Neurology at IU School of Medicine, explains that studies on birth control and stroke risk were conducted during the 1970s when birth control pills contained much higher levels of estrogen than modern day. He says that low-dose estrogen birth control pills can be prescribed if the patient is a non-smoker and does not have migraines with aura, as there is no increased risk of stroke for this population.
For patients who experience migraines with aura, birth control pills containing estrogen are not generally prescribed due to the risk of stroke. Mehrizi says he recommends progesterone-only birth control to these women. He adds that it is unclear whether progesterone-only birth control pills have any helpful effect on migraine.
According to Mehrizi, estrogen replacement post-menopause is not correlated with an increased risk of stroke.
Natural Treatment Options
B vitamins may be one natural treatment option for migraine. One study shows that taking vitamin B6 (pyridoxine) may help lessen the severity and duration of migraine with aura. Other information from the National Headache Foundation points to a study that indicates high doses (400mg/day) of vitamin B2 (riboflavin) may help reduce migraine frequency.
Another study published in Headache: The Journal of Head and Face Pain found that magnesium might be helpful for women who suffer from migraines and are still getting a period. Magnesium, taken 15 days after the start of a women’s period–and taken until the start of the next period–can help women reduce migraines related to their menstrual cycle.
Franklin agrees that supplements like vitamin B2, magnesium oxide, and CoQ10 may help provide some migraine relief.
Mehrizi states that 400 mg doses and higher of vitamin B2 and magnesium oxide can help women who suffer from migraines around their period. It can also help migraines unrelated to menstruation.
Before starting any new supplement regimen, patients should first consult with their physician.
Why Menopause May Bring an End to Migraines
When menopause occurs, many women find their migraine attacks decrease or completely stop. This is because menopause creates stable hormone levels. Without the fluctuation of hormones, the severity and frequency of attacks can decrease.
“In general, women with migraines get better with menopause due to decreased estrogen levels,” said Franklin.
“Hormone fluctuation plays a role in migraine,” said Mehrizi. “In general, there is a reduction in the amount of migraines post-menopause.”
However, it would be inaccurate to make a blanket statement that migraines will resolve for all women following menopause.
Mehrizi says that he does see women who begin getting migraines after menopause.
When to Worry
Although the risk is low, migraine with aura is a risk factor for stroke. Some symptoms of migraine with aura can mimic signs of a stroke, so it is wise to take symptoms seriously. Symptoms to watch include:
- Facial drooping
- Arm weakness
- Speech difficulty
If you experience any of these symptoms, you should call 911.
Other stroke symptoms to watch for:
- Numbness or weakness of the face, arm, or leg, especially on one side of the body
- Confusion, trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Trouble walking, dizziness, loss of balance or coordination
- Severe headache with no known cause
If you experience any of these signs it is best to seek emergency medical attention to rule out the presence of a stroke.