Adults' health-related values and preferences related to reducing or modifying dietary fat intake: a mixed methods systematic review.

Approximately one-third of females will experience migraine in their lifetimes, resulting in significant pain, disability, and socioeconomic impact. There is evidence of a link between endogenous and exogenous hormones and migraine throughout the female life course, but the nature of these associations is not well established. Around the time of menarche, the prevalence of migraine begins to sharply diverge by sex, eventually becoming two to three times greater in females than males. Other reproductive events that cause fluctuation of ovarian hormone levels, such as menstruation, oral contraception use, and pregnancy have been shown to impact the clinical presentation of migraine. Substantial fluctuations in estrogen and progesterone production during perimenopause have been associated with a higher prevalence and intensity of migraine attacks. While some studies have shown a decline in past-year migraine prevalence in the decades following menopause, others have shown consistent migraine prevalence across pre-, peri-, and postmenopausal periods. In addition, the clinical presentation of migraine after menopause varies, with substantial proportions of individuals reporting improvement (8%–36%), worsening (9%–42%), or no change (37%–64%) in migraine. The association of menopause with migraine remains inconclusive, and is complicated by heterogeneity in migraine presentation, menopause type, and use of menopausal hormone therapy (MHT). Previous research on the association between MHT and headache or migraine remains limited and conflicting. A systematic review of migraine and MHT found evidence of differing patterns of migraine (improvement, no change, worsening) following menopause. Data from the Women’s Health Study showed an increased prevalence of migraine among MHT users compared to nonusers. However, as MHT was not randomized and the analysis was cross-sectional, the study was unable to account for confounding by indication, i.e., whether individuals with migraine were more or less likely to be prescribed or take MHT. A registry-based study in Korea found an increased risk of migraine with MHT, regardless of duration, but was limited to spontaneous menopause and migraine recorded in the medical record and potentially confounded by indication due to perimenopausal migraine experiences.