Title
Author
DOI
Article Type
Special Issue
Volume
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Global, regional, and national burden of migraine in postmenopausal women: a 32-year analysis from the global burden of disease study 1990–2021
1Department of Neurology, Dongzhimen Hospital of Beijing University of Chinese Medicine, 100700 Beijing, China
2Department of Neurology, the First Affiliated Hospital of Anhui University of Chinese Medicine, 230031 Hefei, Anhui, China
DOI: 10.22514/jofph.2026.052 Vol.40,Issue 4,July 2026 pp.97-109
Submitted: 04 December 2025 Accepted: 10 March 2026
Published: 12 July 2026
*Corresponding Author(s): Kegang Cao E-mail: kgdoctor@sina.com
Background: Migraine is a major cause of disability globally, yet its epidemiological impact on postmenopausal women (aged ≥55 years) is not well understood. This study aims to fill this knowledge gap by analyzing long-term trends in migraine burden from 1990 to 2021. Methods: Data from the Global Burden of Disease (GBD) 2021 study were utilized to estimate prevalence, incidence, and disability-adjusted life years (DALYs), stratified by age group, Socio-demographic Index (SDI), and geographical region. Temporal trends were assessed using the estimated annual percentage change (EAPC), while socioeconomic inequalities were evaluated through the Slope Index of Inequality (SII) and Concentration Index (CIX). Results: The number of prevalent cases of migraine among postmenopausal women increased by 118.3% globally, rising from 55.29 million to 120.68 million between 1990 and 2021. Age-standardized rates (ASRs) in this population displayed contrasting trends: while age-standardized prevalence and incidence rates experienced slight increases (EAPC: 0.07–0.17), the age-standardized DALY rate (ASDR) remained stable. Middle-SDI regions faced the highest absolute burden of migraine in postmenopausal women and showed the most rapid growth in ASRs. Inequality analyses highlighted persistent socioeconomic disparities, revealing significant efficiency gaps in health resource utilization in high-SDI countries. Conclusions: This study highlights the increasing absolute burden of migraine among postmenopausal women, despite stable age-standardized rates. This underscores the need for context-specific interventions across SDI strata to reduce health inequities and optimize resource allocation in migraine care.
Migraine; Postmenopausal women; Global burden of disease 2021; Age-standardized rates; Socioeconomic inequality
Yufeng Ding,Kegang Cao,Nannan Qian,Yulong Yang,Xuran Zhang. Global, regional, and national burden of migraine in postmenopausal women: a 32-year analysis from the global burden of disease study 1990–2021. Journal of Oral & Facial Pain and Headache. 2026. 40(4);97-109.
[1] Zhang N, Robbins MS. Migraine. Annals of Internal Medicine. 2023; 176: ITC1–ITC16.
[2] Hugger SS, Do TP, Ashina H, Goicochea MT, Jenkins B, Sacco S, et al. Migraine in older adults. The Lancet Neurology. 2023; 22: 934–945.
[3] Ornello R, Caponnetto V, Frattale I, Sacco S. Patterns of migraine in postmenopausal women: a systematic review. Neuropsychiatric Disease and Treatment. 2021; 17: 859–871.
[4] Cen J, Wang Q, Cheng L, Gao Q, Wang H, Sun F. Global, regional, and national burden and trends of migraine among women of childbearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021. The Journal of Headache and Pain. 2024; 25: 96.
[5] Chen ZF, Kong XM, Yang CH, Li XY, Guo H, Wang ZW. Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021. The Journal of Headache and Pain. 2024; 25: 131.
[6] GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2024; 403: 2133–2161.
[7] Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organization Technical Report Series. 1996; 866: 1–107.
[8] Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, 3rd edition. Cephalalgia. 2018; 38: 1–211.
[9] GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018; 17: 954–976.
[10] Yuan L, Tao J, Wang J, She W, Zou Y, Li R, et al. Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021. eClinicalMedicine. 2025; 80: 103051.
[11] Liu Q, Wang H, Chen Z, Xiong J, Huang Y, Zhang S, et al. Global, regional, and national epidemiology of nasopharyngeal carcinoma in middle-aged and elderly patients from 1990 to 2021. Ageing Research Reviews. 2025; 104: 102613.
[12] Lai X, Zhang H, Pouwels KB, Patenaude B, Jit M, Fang H. Estimating global and regional between-country inequality in routine childhood vaccine coverage in 195 countries and territories from 2019 to 2021: a longitudinal study. eClinicalMedicine. 2023; 60: 102042.
[13] Luh J, Cronk R, Bartram J. Assessing progress towards public health, human rights, and international development goals using frontier analysis. PLOS ONE. 2016; 11: e0147663.
[14] He R, Jiang W, Wang C, Li X, Zhou W. Global burden of pancreatic cancer attributable to metabolic risks from 1990 to 2019, with projections of mortality to 2030. BMC Public Health. 2024; 24: 456.
[15] Hambleton IR, Caixeta R, Jeyaseelan SM, Luciani S, Hennis AJM. The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data. Lancet Regional Health—Americas. 2023; 21: 100483.
[16] Olesen J. The international classification of headache disorders: history and future perspectives. Cephalalgia. 2024; 44: 3331024231214731.
[17] Oliveira R, Gil-Gouveia R, Puledda F. CGRP-targeted medication in chronic migraine—systematic review. The Journal of Headache and Pain. 2024; 25: 51.
[18] Karlsson WK, Ostinelli EG, Zhuang ZA, Kokoti L, Christensen RH, Al-Khazali HM, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. The BMJ. 2024; 386: e080107.
[19] Membrilla JA, Alpuente A, Gómez-Dabo L, Raúl GY, Mariño E, Díaz-de-Terán J, et al. “Code Headache”: development of a protocol for optimizing headache management in the emergency room. European Journal of Neurology. 2024; 31: e16484.
[20] Vosoughi K, Stovner LJ, Steiner TJ, Moradi-Lakeh M, Fereshtehnejad SM, Farzadfar F, et al. The burden of headache disorders in the Eastern Mediterranean Region, 1990–2016: findings from the Global Burden of Disease study 2016. The Journal of Headache and Pain. 2019; 20: 40.
[21] Zheng P, Qiu X, Zhang L, Liu P, Peng Z, Huang Z. Comparative analysis of oral disorder burden in China and globally from 1990 to 2021 based on GBD data. Scientific Reports. 2025; 15: 10061.
[22] Seng EK, Martin PR, Houle TT. Lifestyle factors and migraine. The Lancet Neurology. 2022; 21: 911–921.
[23] Portt AE, Orchard C, Chen H, Ge E, Lay C, Smith PM. Migraine and air pollution: a systematic review. Headache. 2023; 63: 1203–1219.
[24] Liang Y, Gao Y, Wang R, Grande G, Monastero R, Dong Y, et al. Migraine, cognitive decline, and dementia in older adults: a population-based study. Journal of Alzheimer’s Disease. 2022; 88: 263–271.
[25] Liu H, Zhang S, Gong Z, Zhao W, Lin X, Liu Y, et al. Association between migraine and cardiovascular disease mortality: a prospective population-based cohort study. Headache. 2023; 63: 1109–1118.
[26] Linde M, Steiner TJ, Chisholm D. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries. The Journal of Headache and Pain. 2015; 16: 15.
[27] La Touche R, Fierro-Marrero J, Sánchez-Ruíz I, Rodríguez de Rivera-Romero B, Cabrera-López CD, et al. Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline. The Journal of Headache and Pain. 2023; 24: 68.
[28] Roldán-Ruiz A, Bertotti G, López-Moreno M. Effects of dietary interventions in patients with migraine: a systematic review. Nutrition Reviews. 2025; 83: e1815–e1827.
[29] Louis S, Carlson AK, Suresh A, Rim J, Mays M, Ontaneda D, et al. Impacts of climate change and air pollution on neurologic health, disease, and practice: a scoping review. Neurology. 2023; 100: 474–483.
[30] Dong HJ, Ran P, Liao DQ, Chen XB, Chen G, Ou YQ, et al. Long-term exposure to air pollutants and new-onset migraine: a large prospective cohort study. Ecotoxicology and Environmental Safety. 2024; 273: 116163.
[31] Lukina AO, Burstein B, Szyszkowicz M. Urban air pollution and emergency department visits related to central nervous system diseases. PLOS ONE. 2022; 17: e0270459.
[32] Jin GL, Su YP, Liu M, Xu Y, Yang J, Liao KJ, et al. Medicinal plants of the genus Gelsemium (Gelsemiaceae, Gentianales)—a review of their phytochemistry, pharmacology, toxicology and traditional use. Journal of Ethnopharmacology. 2014; 152: 33–52.
[33] Nguyen TTP, Nguyen CT, Do HT, Tran HT, Vu TMT, Nghiem S, et al. Determinants of health-seeking behaviors among middle-aged women in Vietnam’s rural-urban transition setting. Frontiers in Public Health. 2023; 10: 967913.
[34] Bener A. Frequency of headache and migraine in Qatar. Neuroepidemiology. 2006; 27: 61–66.
[35] Niu PP, Zhang R, Zhang C, Li S, Li YS. Association between migraine and cerebral white matter hyperintensities in middle-aged and older individuals: a cross-sectional study using the UK Biobank cohort. Headache. 2025; 65: 907–918.
[36] Ripa P, Ornello R, Degan D, Tiseo C, Stewart J, Pistoia F, et al. Migraine in menopausal women: a systematic review. International Journal of Women’s Health. 2015; 7: 773–782.
[37] Bugge NS, Vetvik KG, Alstadhaug KB, Braaten T. Migraine through puberty and menopausal transition-data from the population-based Norwegian Women and Health study (NOWAC). The Journal of Headache and Pain. 2025; 26: 145.
[38] Mathew S, Ailani J. Traditional and novel migraine therapy in the aging population. Current Pain and Headache Reports. 2019; 23: 42.
[39] Chang T, Jung BK, Chai JY, Cho SI. The notable global heterogeneity in the distribution of COVID-19 cases and the association with pre-existing parasitic diseases. PLOS Neglected Tropical Diseases. 2022; 16: e0010826.
[40] Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and menopause are associated with high frequency headache in women with migraine: results of the American Migraine Prevalence and Prevention Study. Headache. 2016; 56: 292–305.
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