Prognosis
For many people, migraines eventually go into remission and sometimes disappear completely, particularly as they age. Estrogen decline after menopause may be responsible for remission in some older women. One study reported that the following people with migraines (called migraineurs) have a better chance of remission:
- Those with a family history of migraine with aura.
- People with migraines that are not triggered by light.
- People with no other primary headaches.
According to another study a history of head trauma or oral contraceptive use predicted a poorer long-term outlook.
Risk for Stroke
Studies have found that migraine or severe headache is a risk factor for stroke in both men and women, especially before age 50. About 19% of all strokes occur in people with a history of migraine. Migraine with aura carries a higher risk for stroke than without auras. Recent results from the Women's Health Initiative study show that women who have migraine with aura are at increased risk of ischemic stroke (in which blood flow to part of the brain is blocked) compared with those who do not have auras and those who have non-migraine headaches. Women under age 55 had the highest risk, with more than double the risk. Researchers caution that while the findings are statistically significant, the total number of strokes is small, as indicated by one study. The absolute risk is also low:
- Women with migraines had a 2.7% risk of stroke, with the time of greatest risk between the ages of 45 and 65.
- Men with migraines had a 4.6% risk and their greatest time of risk was before age 45.
In both genders, the risk diminished with age.
Studies suggest specific stroke risk factors for younger women with migraines, particularly those with auras. Smoking, high blood pressure, and birth control pills considerably raise one's risk ten to twenty-fold. Risk factors include:
- Taking high-estrogen oral contraceptives (OCs). (Whether progesterone-alone contraceptives carry any risk is unknown.)
In migraineurs who take OCs, the risk increases with one or more of the following:
- High blood pressure.
- Smoking.
Interestingly, a 2001 study reported that in people who experienced migraine-related stroke, the frequency of migraines declined afterward.
Emotional Disorders and Quality of Life
Anxiety (particularly panic disorders) and major depression are strongly associated with migraines. In the December 19, 2003, issue of Psychiatric News, researchers reported that postmenopausal women with a history of migraine with aura were more than six times as likely to experience a full-blown panic attack as compared to those without migraine. The finding contradicts earlier studies which have suggested that panic attacks were relatively uncommon in older women. In a 2000 study, 47% of migraine patients had depression. There does not appear to be any causal relationship, although headache and emotional disorders may have some common biologic factors.
In any case, the negative impact of migraines on quality of life, families, and even work productivity is significant and often underrated as a serious complication. Studies indicate that people with migraines have poorer social interactions and emotional health than patients with chronic medical illnesses, including asthma, diabetes, and arthritis.
Migraine and Pregnancy
Effect of Pregnancy on Migraines. In one study, pregnant women with tension or migraine headaches experienced 80% fewer headaches, usually after the end of the first trimester.
Effect of Migraine on the Pregnant Woman or Fetus. Migraine headaches do not pose any added risks during pregnancy to the mother or the fetus, although women with migraines may be at higher risk for having smaller (but not premature) babies.
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