The Prevalence of Headache and Migraine in Relation to Sex Hormone Status In Women: The HUNT 2 Study
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Background and objectives: Boys and girls have approximately the same prevalence of migraine, but after puberty there is a female preponderance. About half of all women with migraine report an association with menstruation (menstrually related headache), though attacks exclusively in relation to menstruation occurs in only 5-8 % (pure menstrual migraine) of these women. Menstrual migraine is typically without aura, it is often more severe and of longer duration. The abrupt decline in estrogen levels before menstruation is thought to be responsible for menstrually related headaches. During pregnancy, when estrogen levels steadily increase, improvement of migraine is reported by 48-80 percent of female migraineurs. When women enter menopause estrogen levels decline and stabilize on a lower level, and although some tend to experience more attacks in the perimenopausal period a decrease in headache prevalence occurs between 50 and 60 years. The aims of this thesis were to examine more specifically in an unselected population the relation between headache, both migraine and nonmigrainous headache, and various states and events related to female sex hormones, in particular levels of estrogen, i.e. use of oral contraceptives in fertile women, use of HRT in postmenopausal women, pregnancy and menarche. Methods: HUNT (Helseundersokelsen i Nord-Trondelag) was conducted in 1995-1997. It consisted of a questionnaire covering a broad range of health related issues, including questions on headache and on menstruation, menarche, menopause, use of hormone supplement, pregnancy and child births. Results:There was a significant association between headache and reported use of estrogen-containing OCs in premenopausal women, both for migraine and for non-migrainous headache. A significant doseresponse relationship between headache and the amount of estrogen in OCs could not be demonstrated. No significant association between headache and OCs containing only gestagen was found.There was a significant association between headache and present use of HRT, both with local and systemic application. This was found for non-migrainous headache and migraine. Both nonmigrainous headache and migraine were more prevalent among users of HRT than among those who had never used HRT.Adjusting for age and educational level, the headache prevalence was lower among pregnant than among non-pregnant women. The association between headache and pregnancy was significant for nulliparous, but not for primi- and multiparous women, evident both for migraine and non-migrainous headache. Among nonpregnant women there was increased headache prevalence among primi- and multiparous women compared with nulliparous .Headache was more prevalent among females with menarche at ≤12 years, both among adolescents and adults, evident for migraine and non-migrainous headache.Conclusions: Headache, especially migraine, was more likely among premenopausal women using oral contraceptives containing estrogen HRT use in the menopause was associated with increased headache prevalence, of both migraine and non-migrainous headaches Headache, both migraine and non-migrainous headache, was less prevalent in nulliparous pregnant women compared with all non-pregnant women, and to nulliparous non-pregnant women. Headache was less prevalent in the third trimester of pregnancy, but not in the first and second trimesters, compared with non-pregnant women. Also in non-pregnant women, headache was less prevalent in nulliparous than in primi- and multiparous women. Headache, both migraine and non-migrainous headache, was more prevalent among both adolescents and adult females with early menarche, when adjusted for important confounders as age, education and BMI.
PublisherNorges teknisk-naturvitenskapelige universitet, Det medisinske fakultet, Institutt for nevromedisin
SeriesDoktoravhandlinger ved NTNU, 1503-8181; 2010:105
Dissertations at the Faculty of Medicine, 0805-7680; 439