Evaluation and management of migraine in midlife women

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Abstract

<p class="first" id="P1">Migraine is highly prevalent in women and, in addition to the pain component, can be associated with significant disability and loss of productivity. Migraine is often connected to fluctuations in hormones (primarily estrogen), commonly arising in puberty, worsening in perimenopause, and quiescing in late menopause. This <i>Practice Pearl</i> discusses the various types of migraine with respect to hormone fluctuations and details acute as well as preventive treatment. </p>

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Migraine in women: the role of hormones and their impact on vascular diseases

Simona Sacco, Silvia Ricci, Diana Degan … (2012)

Migraine is a predominantly female disorder. Menarche, menstruation, pregnancy, and menopause, and also the use of hormonal contraceptives and hormone replacement treatment may influence migraine occurrence. Migraine usually starts after menarche, occurs more frequently in the days just before or during menstruation, and ameliorates during pregnancy and menopause. Those variations are mediated by fluctuation of estrogen levels through their influence on cellular excitability or cerebral vasculature. Moreover, administration of exogenous hormones may cause worsening of migraine as may expose migrainous women to an increased risk of vascular disease. In fact, migraine with aura represents a risk factor for stroke, cardiac disease, and vascular mortality. Studies have shown that administration of combined oral contraceptives to migraineurs may further increase the risk for ischemic stroke. Consequently, in women suffering from migraine with aura caution should be deserved when prescribing combined oral contraceptives. Electronic supplementary material The online version of this article (doi:10.1007/s10194-012-0424-y) contains supplementary material, which is available to authorized users.

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Migraine prevalence, socioeconomic status, and social causation.

Richard Lipton, Walter Stewart, Jason Roy (2013)

To determine whether the known higher prevalence of migraine in lower household (HH) income groups is explained by a higher incidence rate or a lower remission rate. We used data from the American Migraine Prevalence and Prevention Study, a US national sample of 132,674 females (with a 64.3% response rate) and 124,665 males (with a 62.0% response rate) 12 years of age and older. Data were previously collected on migraine symptoms, onset age, and demographics. Previously validated methods applied to the American Migraine Prevalence and Prevention Study data were used to simulate a cohort study. Incidence and remission rates were estimated within 3 sex-specific HH income groups (<$22,500, $22,500-$59,999, and ≥$60,000). The χ² test was used to determine whether the incidence or remission rates differed by HH income group as an explanation for differences in migraine prevalence by HH income. Migraine prevalence increased as HH income decreased for females (χ², p < 0.01) and males (χ², p < 0.01). Differences were not explained by race and other known confounders. Variation in prevalence was explained, in large part, by a higher incidence rate in the lower HH income groups for both females (χ², p < 0.01) and males (χ², p < 0.01). Migraine remission rates did not differ by HH income. The higher incidence of migraine in lower HH income groups is compatible with the social causation hypothesis. Once initiated, migraine remission is independent of HH income. Onset and remission may have etiologically distinct causes.