Fluctuations in hormones can trigger sudden headaches, which means that the lead-up to menopause can be particularly difficult for migraine patients. — dpa
Severe headaches, disorientation, nausea and vomiting – Kristina F. has been plagued by migraine attacks for 30 years.
Two years ago, the attacks suddenly became much more frequent.
“On several days a month, it was so bad that I couldn’t do anything at all,” says the 51-year-old.
She had to figure out for herself, after extensive research, that this was linked to menopause.
“No doctor explained this to me,” she says.
Migraine is one of the most common neurological disorders.
About one in five women are affected, explains German Society for Neurology member and Klinikum Fürth Neurology Clinic head Prof Dr Christian Maihofner.
For about half of these women, the time before their last menstrual period, known as perimenopause, worsens their condition.
Around 40% experience an improvement in migraines during menopause, while about 10% see no change.
The causes are not yet fully understood.
However, it is well established that hormonal factors play a role in migraines.
Women are about twice as likely to be affected as men.
Oestrogen, in particular, is significant, and its levels drop during perimenopause.
According to Prof Maihofner, one common explanation is that this leads to a reduced serotonin level, which is a key neurotransmitter in the body’s pain regulation system.
Additionally, the production of the messenger substance calcitonin gene-related peptide (CGRP), which plays a central role in migraines, appears to be influenced by hormonal changes.
“A hormone replacement therapy (HRT) to increase oestrogen levels can alleviate migraines, but must be carefully considered, as it also carries risks, such as an increased risk of breast cancer,” he says.
He points to numerous other treatment approaches.
These include relaxation techniques such as progressive muscle relaxation, autogenic training and mindfulness-based programmes like MBSR (Mindfulness-Based Stress Reduction).
“Regular endurance sports, for example, jogging three times a week, have also been shown to have a positive effect,” he says.
As women in this age group often face increased stress, stress management is crucial.
“Many of my patients are successful and highly resilient women.
“But everyone has limited resources,” says Prof Maihofner.
Frequent migraine attacks will, of course, impact your social life and career.
Simply relying on painkillers is not enough.
“The autonomic nervous system is out of balance; methods such as meditation or targeted relaxation techniques can help calm and stabilise it.”
While migraines cannot be completely cured, they can often be significantly improved with the right treatment.
It does not necessarily mean that worsening migraine attacks will persist: “Over time, the body adapts to lower oestrogen levels, and not infrequently, migraine attacks improve as a result, although there are no reliable statistics on this yet.”
Prof Dr Gudrun Gossrau, head of a headache clinic in the German city of Dresden, confirms this.
However, in about 20-30% of patients, migraines persist into old age, she says.
Treatment must consider each patient’s individual situation, including any accompanying conditions.
“You need to ask whether regular breaks are being taken, whether a relaxation technique could help, and whether enough exercise is being done.”
Migraine patients need stability, including in their daily routines, she says.
Migraines can also be treated with medication, she adds.
“There are new and specific therapies that work very well, both for prevention and acute cases.
“Help is available, and the first point of contact should be your GP [general practitioner].”
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Kristina is currently trying magnesium as a preventive measure and testing whether avoiding certain foods helps.
Drinking plenty of water, exercising and maintaining regular sleep patterns are important in her experience – “even though it doesn’t always work perfectly in everyday life”.
“Migraines and menopause – I felt like I was on my own with these topics,” she says.
“There simply needs to be more medical expertise, especially on the subject of menopause.” – By Isabell Scheuplein/dpa
