15 General introduction 1 Figure 2. Prevalence of migraine by sex and age categories. The dashed line was derived from the Global Burden of Disease study, whereas the solid line was derived from a Dutch population based study.14, 15 productivity at work or in the household and are more likely to miss social activities. Migraine has a negative impact on health-related quality of life.16 Pregnancy and perimenopause The majority of women with migraine without aura report a decrease in migraine frequency during pregnancy and breastfeeding (Figure 3). During the first trimester of pregnancy, 47% report an improvement in migraine frequency, followed by 83% and 87% during the second and third trimester, respectively. Some women even become completely attack free during pregnancy. A small proportion of women, however, experience a worsening of migraine frequency (8%) or develop new-onset migraine (3-6%) during pregnancy, but these are mostly migraine with aura attacks.17 A woman can be assigned as postmenopausal 12 months after her last menstruation. The period before menopause is called the perimenopause. This perimenopausal phase is an important risk factor for worsening of pre-existing migraine, particularly in women with menstrual migraine (Figure 3).18 Migraine with aura appears to be less influenced by the perimenopause and menopause. From the onset of natural menopause, migraine improves in about two-thirds of women with migraine without aura. The frequency of attacks decreases and the severity of attacks lessens.19
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