Migraine prevalence during menopausal transition

Background. - The effect of menopausal transition on the frequency of migraine has never been the focus of a community-based study. Methods. - A cross-sectional community-based survey was undertaken among Chinese women aged 40 to 54 years in Kinmen, Taiwan. Neurologists diagnosed migraine based on the 1988 International Headache Society classification criteria. Menstrual history including a past or current history of premenstrual syndrome was obtained. Serum levels of estradiol and follicle-stimulating hormone were measured. Results. - The 1-year prevalence of migraine was 16.5% in the 1436 participants. Among the women who had not had hysterectomies and did not report symptoms of premenstrual syndrome, migraine prevalence did not vary according to menopausal status. In contrast, in women with self-reported premenstrual syndrome, menopausal status was a factor in migraine prevalence: the late perimenopausal group had the highest prevalence (31%) and the spontaneous menopausal group had the lowest (7%). Among all menopausal groups, women who had had hysterectomies reported the highest migraine prevalence (27%), with the highest occurring in those with premenstrual syndrome (44%). The presence of low estrogen (<50 pg/mL) and high follicle-stimulating hormone levels (>30 mIU/mL) was associated with lower migraine prevalence, even in the premenopausal and early perimenopausal women. Conclusions. - Our data supported the clinical impression that migraine prevalence increases before menopause and declines after spontaneous menopause. However, in this study, this trend occurred only in women with increased vulnerability to hormonal change, such as those with premenstrual syndrome. The presence of low estrogen and high follicle-stimulating hormone levels predicted lower migraine prevalence, whereas a history of hysterectomy was related to higher prevalence.