How migraine frequency and treatment options can change from puberty to menopause
Women are two to three times more likely than men to experience migraine, and while the exact reasons are not clear, researchers suspect that fluctuating hormone levels play an important role. Dips in estrogen levels cause more frequent, intense migraine attacks in women who already experience migraine, and can even affect those who don’t. As women progress through different life stages, fluctuations in their estrogen levels can cause migraine onset and impact their treatment options.
Read about the stages of a woman’s life that could impact migraine frequency and intensity.
Women experience migraine more often than men after adolescence, and the fluctuations in estrogen levels may provide evidence for hormonal migraine and explain why women are more likely to experience migraine, said Dr. Katherine Hamilton, an Assistant Professor of Clinical Neurology at the University of Pennsylvania.
Advice: If migraine starts during puberty, make sure to consult a physician who specializes in pediatric migraine. Reasonable accommodations during school are worth advocating for, and the support of a doctor can help if needed.
The hormonal fluctuations of a woman’s menstrual cycle can also impact the way she experiences migraine. Many women who live with migraine experience migraine more frequently before, after or throughout the entirety of their menstrual cycle. Different treatment strategies may be more helpful depending on when migraine occurs in a patient’s cycle. Dr. Hamilton recommended patients experiencing menstrual migraine keep a headache diary so they can better identify patterns that can inform optimal treatment.
Advice: Consult with your physician. Many women experience migraine right in the prime of their lives. Don’t wait to find a treatment regimen that could stop migraine attacks in their tracks.
Some women see no difference in their migraine during pregnancy, while others may feel their migraine attacks worsening. But the vast majority of women report that they experience less frequent and less intense migraine attacks while pregnant. According to Dr. Hamilton, women with migraine who are pregnant, or are planning to become pregnant, will likely have to change their treatment plan as the majority of pharmacological migraine treatments are contraindicated for pregnant women and women who are breastfeeding.
Advice: If you are planning to become pregnant, work with your headache specialist to identify treatment options that are safe during pregnancy. If you find out that you are pregnant, consult a physician right away about your treatment options during gestation.
According to Dr. Angeliki Vgontzas, a neurologist at Brigham and Women’s Hospital, women with migraine have a high risk of having a migraine in the postpartum period. While estrogen and progesterone levels soar during pregnancy, both those hormones decrease dramatically after delivery, which may result in the return or first appearance of migraine. About 25% of women have a migraine within two weeks of delivery, and almost half of women have one within the first month.
Advice: If you are one of the many women who experience postpartum headache, make sure to prioritize self-care. Ask for help and get some rest.
Researchers found that breastfeeding does not contribute to increased frequency of migraine, and in fact, there’s data to suggest that breastfeeding could reduce the frequency of migraine. However, when it comes to treatment, breastfeeding mothers have to determine whether the medications they take are excreted in breast milk and whether they are safe for infants. “There are options out there,” said Dr. Vgontzas, “They do have to be individualized, but having migraine should not change your decision about whether to breastfeed or not.”
Advice: Speak with your healthcare provider or consult Motherisk.org about specific migraine treatments that are safe during lactation.
When a woman’s body is transitioning into menopause, the accompanying hormone fluctuations can aggravate migraine. “In many women, migraines can get better in the perimenopausal period but there can be a long period of time where migraine is transiently worse,” said Dr. Hamilton. Patients experiencing perimenopausal migraine have a number of treatment options, unless they have experienced a heart related event. Acute treatments like triptans or NSAIDs are not recommended for use in patients with heart disease. Preventative treatments, however, can be used for these patients.
Advice: If your migraine attacks are worsening in frequency, intensity, and duration, make an appointment with a headache specialist to evaluate treatment options.
Understanding your body is a powerful step to take in managing your migraine. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.