Posts Tagged ‘migraine’

Migraines Worsen During Menopausal Transition

The frequency of migraine attacks is higher in women during perimenopause and postmenopause than in premenopause, according to the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition.

“Fluctuating estrogen levels play an important role in initiating migraine in women,” said study co-author Richard B. Lipton, MD, Co-Director of the Montefiore Headache Center and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine.

“Migraine onset increases with the beginning of menstruation and is more common around the time of bleeding during the menstrual cycle,” he said.

“The trigger factor is thought to be declining estrogen levels.

As menopause approaches, estrogen levels fluctuate and likely trigger migraine.”

Dr. Lipton noted that estrogen and other sex hormones act on the brain and alter the excitability or sensitivity of the nervous system.


The research was conducted as part of the American Migraine Prevalence and Prevention (AMPP) Study, a longitudinal mailed questionnaire survey of 120,000 households selected to be representative of the US population.

Data from the 2006 AMPP Study survey were used.

Women with migraine aged 35 to 65 years were eligible for the analyses.

Women with migraine were classified based on headache frequency.

A high-frequency group experienced 10 or more headache days per month, and a low- or moderate-frequency group experienced episodic migraines on fewer than 10 days per month.

The women also were classified based on menopausal status.

The premenopausal stage was characterized by regular menstrual cycles.

The perimenopausal stage included women with cycle lengths that varied by at least 7 days or periods of no periods lasting 2 to 11 months.

The postmenopausal stage was defined by no periods persisting for at least 12 months.

The analysis included more than 3600 women, mean age 45 years, with about one-third of them in each of the 3 groups.


Frequent headache (10 or more days per month) was 50% to 60% more common among perimenopausal women (12.2%) and menopausal women (12%) compared with premenopausal women (8%).

Consistent with the clinical impression that migraine worsens during the menopausal transition, these data show that the risk of high-frequency headache is greater during perimenopause and postmenopause as compared with premenopause, Dr. Lipton said.

The researchers concluded that longitudinal studies should examine within-person trajectories of headache frequency and the role of hormonal mechanisms among migraineurs during the menopausal transition.

“In the present report, we compared groups of women who were premenopausal and perimenopausal and postmenopausal in the year of the study,” Dr. Lipton said.

In a longitudinal study, we would follow individual women as they transitioned from premenopausal to perimenopausal to postmenopausal and examine the hormonal changes that underlie changes in headache frequency.”

He added: “Clinicians should know that headaches may get worse as women begin the menopausal transition.

When patients experience migraine worsening, clinicians can explain that hormonal changes may be driving the changes.

Controlling headache is one factor that may contribute to the complex decisions about when to recommend hormone replacement therapy.”

The researchers presented their results on June 20, 2014 at the 56th Annual Scientific Meeting of the American Headache Society in Los Angeles.

Relaxation Followed by Stress Triggers Migraines

If you have migraine headaches, they may increase significantly after you relax and then experience heightened stress, according to the results of a new study.

“People with migraine are thought to inherit a predisposition to headaches.

Attacks of migraine headache are initiated in vulnerable individuals when they are exposed to a broad range of triggers,” said study co-author Dawn C. Buse, PhD, Director of Behavioral Medicine, Montefiore Headache Center, and Associate Professor, Clinical Neurology, at the Albert Einstein College of Medicine in New York.

“Our study results support the ‘letdown phenomenon,’” she said.

“That is, relaxation following high perceived stress is a powerful predictor of migraine onset.”

The researchers published their results online on March 26, 2014 in the journal Neurology.


Dr. Buse and colleagues asked 17 patients with migraine to keep electronic diaries for 3 months to examine the relationship of perceptions of stress and relaxation after stress with increased probability of a migraine attack, yielding more than 2000 diary entries, including 110 eligible migraine attacks.

Data were collected using a custom-programmed electronic diary.

Each day patients recorded information about migraine attacks, 2 types of stress ratings, and common migraine triggers.

Triggers included hours of sleep; certain foods, drinks, and alcohol consumed; and menstrual cycle.

They also recorded their mood each day, including feeling happy, sad, relaxed, nervous, lively, and bored.

“We found that a reduction in stress from one day to the next was associated with a nearly 5-fold increased risk of migraine onset within 6 hours,” Dr. Buse said.

The biology of stress is complex, including activation of both neuroendocrine and sympathetic mechanisms, she noted.

“Cortisol rises during times of stress.

If cortisol falls in periods of relaxation after stress that may contribute to the triggering of a migraine attack,” said lead author Richard B. Lipton, MD, Director, Montefiore Headache Center, and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at Einstein.


“This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine,” Dr Buse stated.

“It is very important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allow a major buildup to occur.

Strategies to relax could include exercising, attending a yoga class, taking a walk with your dog, or simply focusing on your breath for a few minutes.”

Behavioral interventions that protect against rising levels of stress also may prevent the peak followed by the valley that leads to an increased risk of migraine attack.

“There are several approaches to stress management with strong scientific support, including cognitive behavioral therapy (CBT), biofeedback, and relaxation therapies,” Dr. Buse said.

“An additional bonus is that these techniques also have scientific evidence for migraine prevention.”

Some approaches require the guidance of a mental health care professional, such as biofeedback and CBT, and some can be self-learned, such as diaphragmatic breathing and guided visual imagery.

“Once learned these techniques can be practiced practically anywhere at any time for the rest of someone’s life,” Dr. Buse noted.

“Based on these findings, we suggest that health care professionals caring for individuals with migraine should incorporating stress management interventions into treatment plans, especially for patients for whom changes in stress levels are triggers for migraine attacks.”