Prevalence and Characteristics of Migraine in Postmenopausal Women: A Systematic Review and Meta-analysis

BackgroundMigraine can improve after menopause, but prior reviews assessing postmenopausal migraine were limited by the available literature, finding improvement in some populations and worsening in others following menopause. This review and meta-analysis investigated the effect of 1) Menopausal status (premenopausal, postmenopausal) on migraine prevalence 2) Menopause Hormone Therapy (MHT) use in postmenopause on migraine prevalence 3) Menopausal status (premenopausal, postmenopausal) on migraine characteristics (headache frequency, migraine frequency, pain intensity).MethodsSearches were conducted across Medline, Scopus, Web of Science and APA PsychINFO in accordance with PRISMA guidance. Included studies measured the prevalence or characteristics of migraine in postmenopausal and/or premenopausal women. Random effects meta-analysis of proportions was conducted to analyse migraine prevalence data, and Robust Bayesian Meta-analysis for migraine characteristics data. Study quality was assessed by modified version of JBI critical appraisal tool for prevalence studies. ResultsFrom 1174 records screened, 30 studies were included (16 prevalence meta-analysis, 10 characteristic meta-analysis). The pooled prevalence of migraine was 22% for premenopausal and 16% for postmenopausal women, but the prevalence was not significantly different between the groups. Migraine prevalence was significantly higher in postmenopausal women using MHT compared to those not. Robust Bayesian meta-analysis showed strong evidence for an effect of menopausal status on migraine characteristics (BF10 = 63.84, g = -0.31), with postmenopausal women exhibiting more severe migraine than premenopausal women, weak evidence in favour of heterogeneity (BFrf= 1.54), and weak evidence against publication bias (BFpb = 0.72). There was weak evidence in favour of a moderation effect of measurement of migraine characteristic used (BF = 1.35) and weak evidence against a moderation effect of study quality (BF = 0.45).ConclusionMigraine prevalence did not differ significantly but was consistently reported as more severe in postmenopausal relative to premenopausal women. Whether this results from different (clinical, non-clinical) samples used in studies or reflects an overall increase in severity in migraine populations in postmenopause is unknown and requires longitudinal investigation. Future studies should consider comorbidities, menopausal symptoms, time since menopause, surgical menopause populations as well as MHT type and initiation to understand migraine course across postmenopause.Registration[PROSPERO ID: CRD420251169810]