The prognosis for a reduction in migraine attacks after menopause improves if there had been a strong relationship between headache and menses during a woman's fertility years. This and related conclusions are part of a new study presented today at the 21st Meeting of the European Neurological Society (ENS) in Lisbon. More than 3,200 neurological experts from around the world are currently discussing the latest developments in all areas of their specialty in the Portuguese capital.

Italian researchers had investigated why the condition of some women suffering from migraine during fertile years improved after menopause while that of others worsened. They also wanted to ascertain whether or not headaches among postmenopausal women could be predicted. Although the data of the study need to be confirmed by further research, the findings can serve as a useful indicator for many women approaching menopause. "It will be possible to tailor therapy protocols for women according to the risk factors that can predict their prognosis after menopause, choosing for example more aggressive strategies in women likely to worsen, or applying a 'wait and see' stance in women likely to improve spontaneously," said Dr. Cecilia Condello, University of Turin (Italy), lead author of the study.

Characteristics of migraine changes after menopause

Changes in hormone levels can cause significant headache - an experience as common as it is painful to many women in the course of their reproductive life. Usually the prevalence of migraine suffering decreases with age, but at menopause migraine can regress, worsen or even stay unchanged. The research group from the University Hospitals of Turin and Novara evaluated 367 post-menopausal women suffering from migraine according to the international headache classification ICHD-II. Among them, 291 involved natural and 76 surgical menopause. The researchers studied if and how the characteristics of migraine changes after menopause. They further analysed possible factors that might predict the outcome of the illness after menopause, such as the association between menstruation and migraine, the number of pregnancies, use of oral estroprogestinic pills and family history, particularly whether the mother also suffered from the illness.

The results surprisingly showed no significant difference between two groups: migraine improved after menopause in 48 (16.5%) of natural menopause patients and in 8 (14.3%) of the surgical menopause women. Out of 48 patients, 44 (or 91.7%) whose headaches improved after menopause had migraine attacks correlated to their menstruation. Such a correlation existed in only 174 (71.6%) of the patients whose migraine worsened or remained unchanged.

Source: ENS Abstract O234 Migraine outcome in postmenopausal women: are there predictive factors?

ENS 2011