Neurologist: Migraines don't go away after menopause; it's a myth that harms women

Migraines don't necessarily go away after menopause; on the contrary, they can get worse and more resistant to treatment in many women, according to a review of studies led by Polish neurologist Dr. Marta Waliszewska-Prosół. The findings contradict the myth that migraines go away after menopause.

"Many years ago, it was assumed that migraines were 'just your nature' and would perhaps go away after giving birth or going through menopause. This is a myth that still affects many women," Dr. Waliszewska-Prosół from the University Center of Neurology and Neurosurgery of the Medical University of Wrocław emphasized in an interview with PAP.

- Such claims mean that women are not taken seriously, they are sent from specialist to specialist, given painkillers and called hysterical. Such patients come to me and say: "it was supposed to be better, but it's worse," she added.

The team, led by Dr. Waliszewska-Prosół, collected and analyzed data from various epidemiological, observational, and experimental studies. Based on this data, they concluded that migraine in perimenopausal women is a complex, serious, and underestimated health problem. Furthermore, women in this age group are almost completely overlooked in scientific research, which translates not only into knowledge gaps and a lack of specialists, but also a lack of systemic solutions in healthcare. "This topic is completely unexplored scientifically, and women in this group are one of the most neglected populations of migraine patients," the scientist noted.

She emphasized that there are no clear diagnostic or therapeutic recommendations for perimenopausal migraine sufferers, and many questions, such as regarding their use of hormone replacement therapy (HRT) or contraception, remain unanswered. "We still have only fragmentary data, from studies on very small groups of patients. There are also isolated animal studies, but these are not sufficient," said Dr. Waliszewska-Prosół.

As she pointed out, migraine is one of the most common neurological diseases, affecting over a billion people worldwide – women three times more often than men. This imbalance stems, among other things, from the hormonal system. Estrogens – female sex hormones – affect not only the reproductive system but also the vascular and nervous systems, playing a significant role in the pathophysiology of migraines.

A particularly turbulent time in a woman's life, hormonally speaking, is around menopause, when estrogen levels fluctuate rapidly and unpredictably. Research shows that many women experience an exacerbation of symptoms during this time. Attacks become more frequent, longer, and more resistant to treatment, and are often accompanied by other symptoms such as insomnia, hot flashes, and anxiety.

Evidence gathered by scientists suggests that one of the greatest challenges in this field is the lack of clear diagnostic guidelines. Therefore, the symptoms of this condition are often confused with other ailments, and hormonal fluctuations make it difficult to make a clear diagnosis. There is also a lack of studies clearly assessing the effectiveness of hormone replacement therapy in migraine treatment – ​​the results of studies to date are contradictory, and the once-commonly reported risk of complications (e.g., stroke in women with migraine with aura) causes many specialists to refrain from prescribing it.

Another problem is the lack of a personalized approach to treatment. Doctors still too rarely consider a patient's individual hormonal profile and migraine history. "For example, in women with migraines without aura, HRT may improve symptoms, but in those with migraines with aura, it may increase the risk of cardiovascular complications. Therefore, each case must be approached individually and separate treatment guidelines developed for both groups," noted Dr. Waliszewska-Prosół.

The expert drew attention to the limited access to modern therapies, such as monoclonal antibodies blocking CGRP, a protein that plays a key role in the pathophysiology of migraines. Although their effectiveness is promising, the high price and lack of reimbursement in many countries mean that they remain out of reach for many patients.

The neurologist explained that there is indeed a group of patients, albeit a relatively small one, whose migraine symptoms may improve or disappear after menopause. "These are people who only experience migraines during their periods. When periods stop, the trigger for the attacks naturally disappears. In other cases, the opposite happens: symptoms worsen, become chronic, and medications stop working," she said.

The situation is complicated by the fact that the pre- and postmenopausal periods are particularly difficult times, when biological and social problems overlap. "Stress related to things like job loss, new social roles, and emerging comorbidities (e.g., hypertension and cancer) can influence the course of the disease. Very often, they mask the problem of migraine, which, however, naturally worsens under the influence of these factors. Patients are shuttled between specialists—from cardiologist to gynecologist and back—with no one making the right therapeutic decisions. Triptans are often no longer available because contraindications include hypertension or age over 65," said the researcher.

That is why, in her opinion, a holistic approach is so important, including self-observation, psychological care, monitoring the course of migraine and the vigilance of primary care physicians.

The researcher noted that migraine remains a stigmatized and downplayed condition. However, as she emphasized, it's a neurological condition like any other, with its characteristic clinical symptoms, complications, and social consequences. "Furthermore, it can alter brain function. The longer it's untreated, the less controllable it becomes and the more difficult it becomes to treat," she explained.

The situation in Poland is exceptionally difficult. Dr. Waliszewska-Prosół's study, conducted several years ago among 3,500 Polish patients, showed that the burden of migraines in our country is among the highest in Europe. "We have the longest waits for drug reimbursement. Patients' quality of life is very poor. High levels of presenteeism—going to work despite illness, which is associated with a significant reduction in productivity—generate enormous costs," she explained.

As he points out, it is high time to “bring migraine out of the underground”. Although it is not a rare disease, it still too often remains invisible. And that is precisely why it requires more attention, better funding and – above all – understanding.

Katarzyna Czechowicz (PAP)

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