Much like the hormonal changes that occur later in life, puberty may trigger or aggravate migraine headaches in young women.
PROVIDENCE, RI—Migraine prevalence increases in females during adolescence, in part due to changing levels of estrogen and progesterone that occur at puberty, researchers reported at the 39th National Meeting of the Child Neurology Society.
In a prospective study, A. David Rothner, MD, and colleagues gave a brief questionnaire to 75 female patients, ages 10 to 20, who saw a pediatric neurologist at the Cleveland Clinic for headaches. Three patients who were not yet menstruating were excluded from the analysis.
Menstrual-related headaches (MRM) were reported in 42.1% of the subjects, and pure menstrual headaches (PMH) were observed in 3.4% of subjects.
More than one-third (39%) of subjects reported that their headaches definitely worsened once menses began, and 39% said they definitely did not. Of their current migraines, 22.9% of participants reported that their migraines intensified prior to day 1 of their menses, while 47% said they believed their migraines did not change or worsen during their menses. In addition, 66.2% reported that menses did not make their migraines more difficult to treat.
In subjects with nonmigraine headaches, 70.5% reported that their headaches did not worsen or change during menses, and 77% of these persons said that menses did not make their headaches more difficult to treat.
Effects of Hormonal Contraception
The results were also stratified by use of hormonal contraception, which 12 subjects reported using. Three reported having headaches prior to menses—two reported that their headaches definitely worsened after menses began, while one said they did not. In the hormonal contraception group, two women reported that their headaches definitely cycled prior to menses, three were not sure, and seven definitely did not experience headache cycling prior to menses.
Four in the contraception and migraine group said their migraine worsened before day 1, one said it became worse between day 2 and 3, and two said it did not worsen. Of those in the contraception plus nonmigraine headache group, one said her headache worsened before day 1, one said it worsened at onset, one said between day 2 and 3, seven said it did not worsen, and one said it varied.
Investigators noted that more patients are needed in order to come to any statistical conclusion.
Less Common in Teens Than in Adults
“Our study suggests that menstrual migraine is less common in teens than in mature women,” said Dr. Rothner, Director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic. “Our study … shows a lower frequency of menstrual migraine than in the only other published paper. We postulate that as women mature and have more and more cycles and more and more migraines, the frequency of menstrual migraine will increase.”
Dr. Rothner noted that a larger prospective, and possibly multi-institutional, study is planned. “If one identifies a young woman with menstrual migraine, we ask that she keep a calendar of her periods. We can than suggest medication to begin the night before her menses begins and prevent the menstrual migraine.”
—Rebecca K. Abma