Headache associated with hormonal fluctuations

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By Christos Sidiropoulos MD and Panayiotis Mitsias MD

Fourteen percent of women report that their attacks are exclusively related to their menstrual periods, but headache diaries reveal that only 0.85% to 7% of women migraineurs have true menstrual migraine. Ten percent of women have onset of their migraines at menarche. Women who had onset of migraines at menarche are more likely to have menstrually-related migraines (Boyle 1999).

Migraine improves during pregnancy in 50% to 90% of women, mostly in the second and third trimesters (Maggioni 1997; Silberstein 1997a; Sances 2003). After menopause, when sex hormone levels stabilize, most women have migraine improvement (Fettes 1999). Neri and colleagues, in a sample of 556 postmenopausal women, found a 13.7% prevalence of primary headaches (Neri et al 1993). Migraine improved in almost two thirds of postmenopausal women migraineurs, but tension-type headache worsened or did not change in 70% of women. None of the study patients reported migraine with aura or cluster headache. Two thirds of migraineurs who underwent surgical menopause reported a worsening of their headache. Ten percent of women migraineurs may continue to experience migraine in the seventh and eighth decades of life.