Special considerations in the management of headache in women

Objective: The pattern of chronic headaches varies during a woman's life cycle, with predictable changes occurring at different stages of life. This review describes the epidemiology of headaches in women from childhood through senescence. The relationship of headache patterns to hormonal changes will be described. The neurophysiology that accompanies hormonal changes is delineated, as well as its relationship to clinical headache. Treatment options to address the changing neurochemical and hormonal physiology of women through their different life stages is also discussed. Data Sources: Thirty-nine journal articles were identified through Medline search and reviewed. These articles include information on epidemiology, hormones, neurotransmitters, and headache. Both basic science and clinical studies were reviewed. Data Synthesis: Menarche is associated with an increase in headache in girls, which persists throughout adulthood. The prevalence of headache peaks around age 38 years, when women are more than 3 times as likely as men to experience headache. Headache prevalence then declines through the remainder of adult life, although women continue to experience headache at least twice as often as men. By age 70 years, 10 percent of women still report chronic headache. These changes in headache patterns during a woman's life are linked to changes in sex hormones, like estradiol. As estradiol changes, there are corresponding changes in levels of neurotransmitters that are important for headache, such as serotonin. Treating headache in women requires adjustments at different life stages to accommodate for these hormonal and neurochemical changes. Conclusion: changes in headache patterns during a woman's life are the result of changes in sex hormones and neurotransmitters. An ability to recognize expected patterns of headache at different life stages is essential for clinical management. Treatment options need to be altered during menses, conception, pregnancy, and menopause to provide optional treatment.