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Perimenopause and Migraines

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The perimenopausal period is a transitional phase to menopause, with a reduction in hormone levels causing symptoms like migraines. Read to know more.

Medically reviewed by

Dr. Khushbu

Published At November 1, 2023
Reviewed AtNovember 1, 2023

Introduction

Migraine is a chronic condition that mainly affects women, occurring at least three times more often in women than in men. Persistent headaches of moderate to severe intensity are induced, accompanied by additional symptoms such as sensitivity to light and sound, as well as feelings of nausea and episodes of vomiting. While about 17 percent of women of all ages experience migraines annually, the highest occurrence happens in pre-menopausal women in their late 30s, at around 30 percent.

Migraine triggers are often specific to each person. Some women notice their migraines are triggered around the start of their menstrual period. This timing is related to the rapid drop in estrogen levels after ovulation. Migraine types are categorized based on their relation to menstrual cycles: pure menstrual migraine (PMM), menstrually related migraine (MRM), and nonmenstrual migraine.

What Is Perimenopause?

Perimenopause signifies the transitional phase when the body is moving towards menopause, which marks the conclusion of the reproductive years. This phase can commence as early as the mid-30s or extend until the mid-50s. During this period, the occurrence of menstrual cycles reduces. This transitional phase is marked by changes in hormonal patterns that can have varying effects on a woman's overall well-being.

Throughout the perimenopausal stage, fertility gradually decreases as the ovaries produce fewer hormones, leading to irregular or even absent menstrual cycles. The levels of estrogen begin to decline, and the body adapts to these hormonal shifts. Consequently, a range of symptoms can emerge, including:

  • Irregular periods.

  • Heavier or lighter menstrual bleeding.

  • Hot flashes.

  • Vaginal dryness.

  • Insomnia.

  • Feelings of depression.

  • Irritability.

How Do Migraines and Perimenopause Connect?

The connection between migraines and perimenopause lies in the changes in estrogen levels during this transitional phase. Estrogen fluctuations can elevate the likelihood of experiencing migraines, with menstrual migraine being a particularly common occurrence among women. Menstrual migraines tend to be longer-lasting and more likely to intensify compared to migraines that happen at other times.

In the perimenopausal period, the menstrual cycles often become shorter, leading to a higher frequency of menstrual migraine attacks. Sleep disturbances are caused by episodes of hot flashes and night sweats. They can also act as triggers for migraines. Even after the cessation of menstrual cycles, the ovaries continue to produce varying amounts of estrogen for several years.

With increased time following menopause, migraines can show improvement. But, this improvement is not an immediate shift. Natural menopause may bring about gradual relief from migraines, while in cases of surgical menopause resulting from the early removal of ovaries, migraines might worsen instead of improving. The complex interplay of hormonal changes and individual variations can impact how migraines evolve during and after perimenopause.

What Are the Types of Migraine Experienced?

Migraine with aura and migraine without aura are two different types of migraines based on the presence or absence of specific warning signs before the headache phase.

Migraine with Aura:

  • Aura: An aura is a set of warning symptoms that can occur before the actual headache phase of a migraine. It typically involves sensory changes or disturbances that affect vision, sensation, or speech.

  • Symptoms: These warning signs can include seeing flashing lights, zigzag lines, blind spots, or experiencing tingling or numbness in certain areas of the body.

  • Duration: Auras usually last for about 20 minutes to an hour and generally fade away before the headache begins.

  • Headache: The aura is often followed by a headache, which can be intense, and with additional migraine symptoms, which include sensitivity to light and sound, nausea, and episodes of vomiting.

Migraine without Aura:

  • No Warning Signs: Migraine without aura, also known as common migraine, does not involve the sensory changes or disturbances that characterize an aura.

  • Headache: The headache in this type of migraine can still be severe and come with other symptoms.

  • Triggers: The triggers and causes of migraine without aura are similar to those of migraine with aura. It can be set off by factors like stress, certain foods, hormonal changes, and more.

What Are the Migraine Triggers in Perimenopause?

  • Hormonal Fluctuations: The reduction in estrogen levels is connected to a decrease in serotonin, a brain neurotransmitter. This drop in serotonin can disrupt the trigeminal nerve's function, potentially triggering migraines. Hormonal fluctuations are a major contributor to menstrual cycle-related migraines.

  • Heavy Menstrual Bleeding: Perimenopause can lead to heavy menstrual bleeding, causing a depletion of iron levels in the body. Iron deficiency can be an additional factor triggering migraines.

  • Increased Prostaglandin: Heavy menstrual bleeding boosts the release of prostaglandins, compounds involved in various bodily processes. Prostaglandins aid in shedding the uterine lining during menstruation. They also contribute to inflammation and the dilation of blood vessels. Both of these actions can contribute to the onset of migraines.

  • Sleep Alterations: Perimenopause often brings about disrupted sleep patterns. These sleep disturbances can act as a trigger for migraines.

Recognizing these interconnected factors helps in understanding the complex relationship between perimenopause and migraines. It is crucial to consider these triggers when managing and seeking relief from migraines during this transitional phase.

How to Manage Perimenopausal Migraine?

  1. Consult a Healthcare Provider: Discuss the symptoms with a healthcare provider to determine an effective treatment plan.

  2. Symptomatic Treatment: Seek effective treatment to alleviate symptoms and manage migraines.

  3. Hormone Replacement Therapy (HRT):

    1. Consider HRT for managing hot flashes and night sweats.

    2. Note that HRT can potentially worsen migraines due to increased estrogen levels.

    3. Women without aura may benefit from hormone therapy that suppresses ovarian activity.

  4. Combined Oral Contraceptives:

    1. Generally safe until age 50 for most healthy women.

    2. Safe for women with migraines without aura.

    3. Women with migraine aura should consider progestin-only methods.

  5. Stabilizing Hormonal Fluctuations:

    1. Choose estrogen patches, gels, or sprays for stable hormonal levels.

    2. Transdermal estrogen is safer for women with migraine aura, as it bypasses digestion.

  6. Hysterectomy and Migraines: For women who've had a hysterectomy and experienced migraines, progesterone may be preferable.

  7. Non-Hormonal Therapies: Drugs like Escitalopram and Venlafaxine, which act on serotonin, can effectively reduce hot flashes and sweats.

  8. Lifestyle Modifications:

    1. Incorporate regular exercise and maintain a healthy body weight.

    2. Consider talking therapies such as cognitive behavioral therapy (CBT).

Each individual's experience and response to treatments can vary, so it is important to find an approach that suits the needs and preferences of individuals.

Conclusion

Perimenopause signifies a phase marked by a decline in estrogen levels within a woman's body. This transition triggers both physical and mental changes that are encountered by a majority of women. Perimenopause and menopause represent important stages of reproductive aging, holding significant importance in a woman's life journey.

Signs and symptoms during this phase can vary widely from one woman to another, requiring individualized care and attention as they go through these transformative periods. As part of these changes, perimenopausal symptoms, including migraines, can emerge. These symptoms can be effectively managed by engaging in open discussions with healthcare professionals, enabling the adoption of appropriate treatment strategies for each individual's needs.

These steps not only help in managing the challenges associated with perimenopause but also contribute to enhancing overall well-being and making this phase of life more comfortable and fulfilling.

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Dr. Khushbu
Dr. Khushbu

Obstetrics and Gynecology

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perimenopausemigraine
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