How menopause status and sleep quality can impact migraine symptoms

• Researchers compared the effects of a history of migraines and sleep quality in premenopausal and perimenopausal women.
• They found that a history of migraines predicts sleep quality in premenopausal but not perimenopausal women.
• They concluded that healthcare professionals should consider menopause status when addressing poor sleep in women.

Women are more likely than men to have poor sleep quality. Studies also show that women are 2-3 times more likely than men to have migraines.

Other research shows that poor sleep quality is linked to an increased risk of migraines. While migraines tend to worsen during the menopause transition—also known as perimenopause—they also improve after menopause.

Studying the link between poor sleep and migraines during the menopausal transition could help researchers develop treatments and preventative strategies to improve sleep and reduce migraines among perimenopausal women.

Recently, researchers compared migraine and sleep quality between premenopausal women and perimenopausal women.

They found a link between a history of migraine and poor sleep in both pre-menopausal women, and perimenopausal women, but found that the poor sleep in perimenopausal women was likely due to menopause symptoms.

“It is not surprising that sleep quality can change (worsen) in premenopausal women with a history of migraines,” Dr. Nasima Diana Shadbehr, director of the Headache Clinic at Cedars-Sinai in Los Angeles, who was not involved in the study, told Medical News Today, “However, it is surprising that this same finding was not seen in perimenopausal women.”

The study will be presented at The North American Menopause Society (NAMS) Annual Meeting.

Reasons for poor sleep

For the study, the researchers analyzed data from 2,067 women. Their average age was 43.2 years old, and 53.5% of the women were perimenopausal.

The researchers assessed the participants’ history of migraine via self-report and assessed sleep quality and duration using the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

Overall, 28.7% of women reported a history of migraine, and 71.2% met the criteria for poor sleep.

The researchers also collected data including body mass index (BMI), anxiety, depression, and severity of hot flashes.

The researchers found that a history of migraine predicted poor sleep in both premenopausal and perimenopausal women.

However, factors that occur during the menopause transition—including BMI, anxiety, depression, and the severity of hot flashes—were more likely to explain poor sleep in perimenopausal women than a history of migraines alone.

The researchers found no link between migraine history and sleep duration in either pre-or perimenopausal women.

The link between sleep quality, migraine

When asked what might explain the link between sleep quality and history of migraines in pre and perimenopausal women, Dr. Stephanie Faubion, director of Mayo Clinic’s Center for Women’s Health and medical director of The North American Menopause Society, one of the study’s authors, told MNT:

“The potential link between sleep quality and migraine may be that there may be some shared brain pathways that affect both.”

Dr. Medhat Mikhael, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California, who was also not involved in the study, told MNT that estrogen regulates the female reproductive system and chemicals that impact the sensation of pain.

He noted that a decrease in estrogen levels—especially in middle-aged women around their menstrual cycles—could therefore induce migraines.

He added that as women are more prone to mood disorders such as anxiety and depression than men, they may also have more sleep problems too as many of the neurochemicals disrupted in these conditions are also involved in sleep regulation.

In conversation with MNT, Summer Ghaith, M.D. candidate at Mayo Clinic Alix School of Medicine, one of the study’s authors, agreed that sex hormones play a large role in women’s experience of migraines and poor sleep, and may also explain why women are more likely than men to experience both conditions.

“Hormone changes, specifically the premenstrual drop in estrogen levels and around the menopause transition, are thought to cause women to experience worsening migraine symptoms. Sleep may also be impacted by hormonal variations during perimenopause.”
— Summer Ghaith

“It is conceivable that migraine and sleep may be more strongly influenced by other morbidities during the menopause transition, making the independent link between migraine and sleep weaker during this stage,” she added.

“Therefore, these differences may come down to the role of hot flashes and night sweats, as well as mood disorders, such as depression and anxiety,” she continued.

The researchers concluded that management strategies to address poor sleep might differ depending on menopause status.

Limitations

When asked about the study’s limitations, Dr. Faubion noted that due to the study’s cross-sectional nature, they could only establish a correlation and not causation.

“I would say some limitations include a limited demographic ie. 92.2% were white women, 86% with at least some college. A study looking at a wider range of patient demographics would help make the findings more applicable,” Dr. Shadbehr added.

She further noted that the study nevertheless had some major strengths, including a large sample size, and statistically significant results.

“Regardless of the findings, I think it brings up the important point that we should take a holistic approach to treating our patients with migraines- including considering what stage of life they are in. Addressing sleep is an important factor when treating migraines.”
— Dr. Nasima Diana Shadbehr

“Additionally, hormonal shifts—specifically drops in estrogen—are known to affect/trigger migraines, and considering all the changes a woman’s body is going through during premenopause and perimenopause helps us serve our patients better,” she concluded.

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