Factors associated with postmenopausal migraine persistence: A retrospective tertiary headache clinic‐based study

OBJECTIVES/BACKGROUND: Migraine often improves after menopause; however, many women continue to have persistent symptoms. The factors associated with persistence and changes in migraine characteristics after menopause remain unclear. This study aimed to identify factors associated with migraine persistence after menopause and describe changes in migraine characteristics after menopause in a sample of Egyptian women compared to before menopause. METHODS: Five Egyptian headache clinics participated in this retrospective cohort study (September 2025-March 2026). Women coded with migraine, born between 1971 and 1978, registered at any of these clinics, were invited to a face-to-face interview. Patients were classified as having persistent or resolved migraine after menopause. Premenopausal migraine severity and frequency, measured using a visual analog scale and monthly migraine days, were extracted from the database for comparison with postmenopausal values. Menopausal symptoms were assessed using the Menopause Rating Scale. RESULTS: Two hundred nineteen women with persistent migraine after menopause, and another 96 women with resolved migraine, agreed to participate. Despite persistence, postmenopausal assessments showed significant reductions in median visual analog scale scores (7.0 [6.0-8.0] vs. 6.0 [4.0-7.0]), median monthly migraine days (8.0 [5.0-14.0] vs. 6.0 [3.0-10.0]), and the proportion of patients reporting aura (134/219 [61.2%] vs. 116/219 [53.0%]) (all p < 0.01) compared with the premenopausal period. Factors associated with postmenopausal migraine persistence are a first-degree relative with migraine (adjusted odds ratio [aOR] = 1.92, 95% CI = 1.07-3.43, p = 0.029), insomnia (aOR = 2.22, 95% CI = 1.16-4.24, p = 0.016), and surgical menopause (aOR = 4.00, 95% CI = 1.29-12.41, p = 0.017). CONCLUSION: Migraine showed overall improvement in severity and frequency if it persisted after menopause. Persistence was associated with a first-degree relative with migraine and insomnia. Surgical menopause also showed an association, but this estimate was imprecise due to small numbers and should be interpreted cautiously. However, the generalizability of these results was limited because the study was clinic-based rather than population-based.