In the first 3 months of pregnancy, there may be an aggravation of migraine. After that, however, a large proportion of migraineurs will be symptom-free during the second and third trimesters of pregnancy. This is especially true for women who suffer from a menstrual migraine. In the puerperium, the migraine symptoms can increase again. On the other hand, 25% of migraineurs show no change in their attack frequency during pregnancy.
The improvement in migraine during pregnancy should be based on the consistently high and stable levels of the female hormones, the deterioration after birth on their waste. The progressively increasing endorphin level during this time should also play a favorable role.
Migraine and combined hormonal contraceptives (CHC)
Several epidemiological studies have shown that migraine correlates with a slightly increased risk of circulatory disorders of the brain or strokes, and that this risk is greater in younger years. At age 40, this risk is 2.8-fold higher than for non-migraine women, and 6-fold for migraine with aura.
The use of combined hormonal contraceptives in migraineurs of any age group, with or without aura, further increases the risk of stroke. Other risk factors such as diabetes, hypertension and smoking result in a further increase in the risk of multiplication. It is known that migraine plus birth control pills and smoking are associated with a highly significant increase in risk (factor 30). Migraineurs should discuss their contraceptive issues with the specialist thoroughly. CHC can also initiate a migraine or worsen an existing migraine. If a migraine occurs for the first time under CHC, it should be discontinued immediately.Contraceptives containing only progestins do not increase the risk of stroke.
Postmenopausal migraine (time after last menstrual period)
Contrary to the earlier opinion that migraine disappears after menopause, several studies have shown the opposite. Many women experience a worsening of their migraines before and during menopause. These are mainly patients who previously suffered from menstrual migraine. The explanation of this deterioration is in turn attributed to the strong and irregular hormone fluctuations during this time.
The onset of migraine depends on other factors that are still unknown, since the disease predominantly affects women late in the menopause when it reaches low levels of hormones. For 70-year-olds twice as many women as men are affected.