Women’s Health
Migraine Trajectories Across the Menopausal Transition by Aura Status in the Nurses’ Health Study 2 Holly Crowe* Holly Crowe Crowe Crowe Crowe Crowe Brigham and Women’s Hospital
Nearly 25% of women experience migraine as they approach the menopausal transition. Although migraine prevalence seems to increase during perimenopause and decline after menopause, epidemiologic evidence is inconsistent and distinctions for migraine aura status are unknown. We used data from 21,696 participants in the Nurses’ Health Study II to characterize migraine trajectories overall and by migraine type (with and without aura). Self-reported physician-diagnosed migraine was assessed serially over 28 years. We used participant-reported final menstrual period (FMP) date to identify migraine before perimenopause (>2 years before FMP), during perimenopause (±2 years from FMP), and after menopause (>2 years after FMP). We calculated frequencies for eight possible migraine trajectories across the transition by aura status. Nineteen percent of participants reported premenopausal migraine (N=4,101), of whom 51% had migraine with aura. Nearly half also reported perimenopausal migraine (N=1,964), and two-thirds of these had migraine with aura. Nearly 16% of women overall experienced post-menopausal migraine, including 64% of women with both pre- and perimenopausal migraine (N=1,250). Among those with migraine at all time points, 70% had migraine with aura, compared with 31% of those with premenopausal migraine only. Among participants without premenopausal migraine (N=17,595), 83% never experienced migraine across the transition, 14% had new-onset perimenopausal migraine, and 3% had new-onset postmenopausal migraine. Approximately half of those with new onset perimenopausal migraine continued to experience migraine after menopause and 41% had migraine with aura. Migraine trajectories across the menopausal transition are heterogeneous, and migraine with aura is more common among those with enduring migraine. These findings parallel evidence of greater persistence of migraine with aura during pregnancy and highlight etiologic differences by migraine subtype.
