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ATLANTA -- A history of migraines was linked with poor sleep among women before, but not during, the menopausal transition, according to a cross-sectional analysis.

Before adjustment for risk factors, migraine was a predictor of poor sleep in both premenopausal (OR 1.6, 95% CI 1.1-2.1) and perimenopausal women (OR 1.6, 95% CI 1.2-2.2).

But after adjustment for risk factors such as anxiety, depression, body mass index (BMI), and hot flash severity, the association between migraines and sleep history was only significant among premenopausal women (OR 1.4, 95% CI 1.0-2.0), reported Summer Ghaith, BS, an MD/JD candidate at the Mayo Clinic School of Medicine in Phoenix.

Ghaith noted in a presentation at the North American Menopause Society (NAMS) annual meeting that the relationship between migraines and poor sleep in women during menopause may be explained by other factors that are known to affect sleep in the menopausal transition, such as elevated BMI, anxiety and depression, and the onset of vasomotor symptoms.

"Clinicians caring for women should query female migraineurs about sleep, irrespective of menopause status," Ghaith said. "An important component of management of migraine and sleep disturbances during perimenopause may include addressing other symptoms and conditions that commonly affect women during this menopause transition."

Migraine affects one in five U.S. women, with the frequency of migraines rising during the transition to menopause, Ghaith said. Women are significantly more likely to experience migraines than men, potentially because of the role of sex hormones. While poor sleep quality affects around a quarter of midlife women, the association between sleep and migraines during menopause is unclear, Ghaith said.

Ghaith's group conducted a cross-sectional analysis of women in the Data Registry on the Experiences of Aging, Menopause, and Sexuality (DREAMS). The study included women, ages 18-59, who were seen at the Mayo Clinic in Arizona, Florida, or Minnesota from May 2015 to May 2021.

Study participants self-reported their migraine history, and researchers assessed their sleep quality through the use of the Pittsburgh Sleep Quality Index, where a score above 5 indicates poor sleep. The researchers also measured sleep duration, with 7 or fewer hours each night considered short sleep, but no relationship between migraines and sleep duration was found.

The researchers included 2,067 women in the analysis. Participants had an average age of 43. The majority were white, partnered, and had at least some college education. Nearly half were postmenopausal (47%) while the rest were perimenopausal. Overall, 29% of women included in the study reported a history of migraine, and 71% met the criteria for poor sleep.

Anxiety and depression, higher BMI, and hot flash severity, were each associated with poor sleep. Obesity and hormone therapy, however, were not significant predictors of poor sleep, the researchers found.

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