Migraine in women : Epidemiological, clinical, genetic, and experimental aspects

Abstract: Migraine is a significant public-health problem. Few studies have focused on migraine inmiddle-aged and older women in the general population. The primary aim of this study was tocharacterise migraine, to analyse how migraine changes with age, and to test hypotheses aboutsome factors possibly relevant to the aetiology and pathophysiology of migraine.Women aged 40-74 years in Uppsala County are invited regularly to a mammographyscreening program (MSP). The lifetime prevalence and the one-year prevalence of migraineheadache in a sample (n = 728) of women attending the MSP was 31% and 18%, respectively.The one-year prevalence of migraine headache declined with age, by approximately 50% perdecade. The decline was accompanied by a decrease in pain intensity, suggesting a causalrelationship. Hormonal replacement therapy was not a significant factor for migraineheadache. The prevalence of transient visual disturbances (TVDs) resembling migraine auraswas 13% in women attending the MSP. The characteristics of these TVDs were the same as infemale migraine patients, suggesting that TVDs are migraine phenomena. Deficientmetabolism due to mutations in the genes of the xenobiotic metabolising enzymes cytochromeP450 2D6 and glutathione S-transferase M1 was not deemed to be important in the aetiologyof migraine. Eight per cent of women who ingested a glass of ice-cold water experienced amomentary headache. Women who experienced one or more migraine headache attacks in theprevious year (active migraine headache) were twice as likely to experience a headacheinduced by the cold water as non-migrainous women. This indicates that migraine and cold induced headache have a common pathogenetic mechanism.To conclude, migraine phenomena are common in middle-aged and older women. Migraineheadache disappears with age, probably because the intensity decreases. Active migraineheadache facilitates the perception of forehead pain caused by the ingestion of cold water.