Ovarian Hormones and Migraine Headache: Understanding Mechanisms and Pathogenesis--Part 2

Vincent T. Martin, MD; Michael Behbehani, PhD


Headache. 2006;46(3):365-386. 

In This Article


Menarche refers to the onset of menstruation during puberty. The typical age range of menarche is 9.1 to 17.7 years with a median age of 12.8 years within American girls.[1,2] The initial menstrual cycles are often anovulatory and may remain so for the first 12 to 18 months after the onset of menarche. Serum estradiol levels range from 10 to 156 pg/mL during puberty prior to the onset of ovulatory menstrual cycles; serum levels of estrogen and progesterone similar to those encountered during the adult menstrual cycle may not be reached until several years after the onset of menarche.[3]

The prevalence of migraine is similar in preadolescent boys and girls, but diverges at the time of menarche.[4] After menarche, the prevalence is 2 to 3 times higher in girls than in boys and remains so throughout most of the reproductive years. The age of onset of migraine tends to differ between girls experiencing attacks of migraine with and without aura. Stewart et al[5] reported the peak incidence of migraine was 12 to 13 years of age for girls experiencing migraine with aura (MWA) (14.1 cases per 1000 person years) and 14 to 17 years of age for those experiencing migraine without aura (MWoA) (18.9 cases per 1000 person years). Thus MWoA most commonly begins after the onset of menarche, while MWA usually begins shortly before or at the time of menarche. Since ovulation and regular menstrual cycles may not develop for 1 to 2 years after menarche, it is likely that the onset of MWoA is associated with the establishment of the female menstrual cycle.


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