Migraine pain and symptoms affect more than 38 million Americans, between 10% and 15% of the population. Migraine is the most common form of disabling headache for which patients seek medical treatment. Migraine headaches tend to appear initially between the ages of 10 and 45 and most commonly occur between the ages of 15 and 55. Sometimes they may begin later in life, though migraines often become less severe and less frequent with age for those who have them. Most people have a family history of migraine or of disabling headache, which is now understood to be consistent with a neurogenic cause.
Migraines occur about 3 times more often in women than men and are most common in women in their reproductive years, between the ages of 20 and 45; before puberty migraine rates are similar if not slightly higher for boys than girls. Women tend to report more painful and longer lasting headaches and more symptoms, such as nausea and vomiting than men. More than half of migraines in women occur right before, during, or after the woman has her period. This is often called “menstrual migraine,” though most of these patients will also have migraine headaches at other times of the month as well (Migraine fact sheet, 2008, womenshealth.gov).
How the menstrual cycle and migraine are linked is unclear. Just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because estrogen affects chemicals in the brain. If migraine headaches are closely linked to the menstrual cycle, menopause may make them less severe. With aging, the nausea and vomiting may decrease as well. About two-thirds of women with migraines report that their symptoms improve with menopause; however, for some women, menopause worsens migraine or triggers migraines to start. In general, though, the worsening of migraine symptoms goes away once menopause is complete.
Birth control pills improve migraine for some women. The pills may help reduce the number and severity of some women’s attacks, though others have different experiences. Some women, but not all, may have fewer migraines while they are pregnant, when medications must be chosen carefully. Lifestyle changes, such as establishing a regular sleep pattern and eating healthy foods, can also be helpful.