Migraine is one of the most common neurological disorders, affecting women disproportionally at a rate of 3:1 compared to men.
It is well established that sex hormones play an important role in the epidemiology of migraine. As children, boys and girls are equally affected, but the female predominance emerges after puberty.
Many woman migraineurs note an increase in attacks in the perimenstrual period. Compared with non menstrual migraines, menstrual migraines cause more impairment, are longer, and are more likely to relapse within 24 hours, increasing their burden.
Gender is also a risk factor for chronification of headache, likely due to hormonal differences, and women have a higher prevalence of chronic daily headache than men. In addition, several studies have suggested that women have more frequent, more severe, and more long lasting headaches when compared with men, and experience more of the associated symptoms of light and noise sensitivity and nausea.
For some women, a worsening of migraine may be the first indicator of pregnancy. Factors contributing to this worsening include the hormonal changes of pregnancy and likely nausea, dehydration, lack of sleep and stress. However 60 to 87% of women with menstrually related migraine (MRM) improve in the second and third trimesters.
During pregnancy, to minimize risks to the developing fetus, whilst reducing pain and disability in the mother, non medication approaches are the mainstay of treatment. These include lifestyle factors, such as a healthy diet and regular sleep, maintaining good hydration, minimizing caffeine intake and avoiding triggers, as well as acupuncture, icepacks or heat, and moderate exercise as tolerated.
Migraine symptoms often become apparent in the postpartum period as oestrogen levels rapidly fall. Breastfeeding may delay the return of migraines by keeping oestrogen levels elevated.
For many women the perimenopausal time brings worsening migraines. This transition is caused by fluctuating ovarian function with fluctuating hormone levels resulting in irregular periods, hot flushes, sleeplessness, and difficulty concentrating. This chaotic hormonal variation can lead to higher migraine frequency and worsening severity, and some women with prior, relatively inactive disease, can see a recurrence of migraine attacks.
Migraine is one of the most common neurological conditions, and is the third most common disabling disorder globally. Women are disproportionately affected by a ratio of 3:1, compared to men, in part due to hormonal differences, with changes in oestrogen appearing to be the principal factor.
Migraine in Women, Broner MD et al, Semin Neurol 2017; 37:601-610
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