I’ve suffered from migraines for as long as I can remember, and I’ve been counting down the days until I hit menopause so perhaps these terrors will finally leave me alone.
I even asked my neurologist if he could jump-start me into early menopause (he refused).
That was, until I learned that before women hit menopause, their migraines will most likely be the worst they’ve ever been. Say what?! Now I’m doing my best to stop menopause from its pending arrival. But in the meantime, I spoke with neurologists and examined studies to learn what to expect.
First, the good news: Migraines do tend to decrease as you age. You just have to get through 25 years of them (perhaps not the greatest.news ever), and then most women should be pain-free, according to a 2007 study from researchers in Sweden.
Between the ages of 30 and 39, 24 percent of women have migraines, while 7 percent of men suffer from them, says Juliette Preston, neurologist and director of the headache center at Oregon Health and Science University.
“Each decade, it decreases,” Preston says.
Over the age of 60, there are still 5 percent of women who have migraines. Even those who are in their 80s or 90s have migraines — but those are few and far between, Preston says.
Essentially, estrogen is the largest trigger for migraines. That’s why women are three times more likely to have a migraine than men, Preston says. Two days before your period, your estrogen drops, so that’s why migraines are more likely to pop up at that point.
In your late 40s, you have a more erratic concentration of estrogen, so this is typically the worst time for migraine sufferers.
“But after menopause, estrogen drops and gets steady, and your migraines will drop,” Preston says. “But not every woman will get better.”
It has to do with whether or not your migraines have a menstrual component, says Seth Stoller, neurologist and director of the headache center at Overlook Medical Center in Summit, N.J.
“In patients specifically where there is a menstrual component, headaches may decrease to a point where there are no migraines,” Stoller says.
Regardless of the reason for your migraines, there’s help.
There’s no FDA-approved treatment specifically for age-related migraines or postmenopausal migraines, but there are treatments that should work in each stage.
While you may have been taking triptan therapy through your 20s, 30s, 40s and possibly your 50s, your doctor may have you avoid it as you age, as it can constrict blood vessels.
“This could be detrimental to anyone with an underlying heart condition, and should be evaluated thoroughly in anyone over 65 prior to starting triptan therapy,” Stoller says.
Alternatively, Frova is a treatment that’s often given during the premenstrual or perimenopausal time to help curtail the severity and duration of symptoms for migraines, but should be carefully assessed in the geriatric population, Stoller says.
Taking magnesium supplements (400 mg) daily when you’re perimenopausal may also help, Preston says, as it suppresses menstrual migraines.
You may also go on a continuous birth control pill, though after a certain age, extra estrogen can increase the incidence of stroke, and it’s not recommended for those older than 50, Preston says.
I’m personally hoping that my daily combo of Topamax and nortriptyline with a topping of sumatriptan will see me through the worst of it. I also asked Preston if she had a pill that could skip me (and others — I’m happy to share!) right over perimenopause and into sweet, sweet menopause.
“I wish,” she says. “I don’t have a trick, or else I would share it with my patients.”
As always, talk to your doctor before starting any new medication.
Paige Vickers
