Patterns of Migraine in Postmenopausal Women: A Systematic Review
Received 13 January 2021
Accepted for publication 4 March 2021
Published 19 March 2021 Volume 2021:17 Pages 859—871
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Raffaele Ornello,1 Valeria Caponnetto,1 Ilaria Frattale,2 Simona Sacco1
1Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy; 2Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy
Correspondence: Raffaele Ornello
Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
Email [email protected]
Introduction: Migraine prevalence is higher in fertile than in postmenopausal women. However, few literature data are available on the prevalence and characteristics of migraine after the menopause and on the effect of hormones in postmenopausal women with migraine.
Methods: We performed a systematic literature review of studies available on Scopus and Web of Science from the beginning off indexing until October 18th, 2020. We included both randomized trials and observational studies.
Results: We included 12 papers, six of which assessed the prevalence and characteristics of migraine in postmenopausal women, while the other six assessed the effect of hormones on migraine after the menopause. One of the studies was a randomized trial, while the remaining 11 were observational studies. Ten studies were clinic-based, while the remaining two were population-based. Studies assessing the prevalence and characteristics of migraine after the menopause reported inconsistent findings; in studies performed in headache clinics, likely affected by selection bias towards the most severe cases, a relevant proportion of women reported migraine worsening after the menopause. Studies assessing the effect of hormones on migraine after the menopause showed that postmenopausal hormone replacement therapy was invariably associated with migraine worsening, if containing estrogen.
Conclusion: Our systematic review showed that migraine could be a relevant health problem in postmenopausal women, mostly in headache clinics. However, the available studies allow a limited assessment of the prevalence and characteristics of postmenopausal migraine. Further large studies are needed to better determine the burden of migraine after the menopause according to migraine characteristics and the impact of hormonal treatments.
Keywords: migraine, menopause, systematic review, hormone replacement treatment
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