Menopause and Migraine
Menopause and Migraine: For women whose migraine has been closely linked with their menstrual cycle, the elimination of that trigger with the onset of menopause can result in real improvement, although it is rare for attacks to disappear entirely. In contrast to physiologic menopause, surgical menopause results in worsening of migraine in two thirds of cases.
Getting older is also usually associated with both headaches and associated symptoms becoming less severe so it may not be only menopause, but also aging, which produces headache improvement in many cases.
Perimenopause is sometimes associated with worsening migraine as a result of hormone fluctuations. In addition, irregular menses can make management of the condition less predictable. As menopause progresses, the plasma levels of sex steroids decline and migraine frequently abates.
Even so, in the general population between the ages of 55 and 60, the incidence of migraine in women is still higher than men. This suggests that some factors other than hormones contribute to the predominance of migraine in women, but the reasons for this are not well understood.
Management of perimenopausal migraine
Regular acute and prophylactic measures should be used, bearing in mind that Triptans are indicated only in adults aged 18-65. If attacks linked to irregular menses or other perimenopausal symptoms are apparent, HRT may be considered as an option, provided that there are no contraindications to its use.
Hormone Replacement Therapy
HRT is licensed for the control of menopausal symptoms and the prevention of osteoporosis and has a variable effect on migraine frequency. Research as shown that it is almost a likely to worsen migraine than improve it. It remains virtually impossible to predict what a given woman will experience.
Subcutaneous routes of oestrogen administration are more likely to improve migraine than oral routes.
Lower doses are recommended for migraine, although there may well be some trade off with other menopausal symptoms.
Continuous oestrogen replacement therapy may be preferable to cyclical dosing
For optimal results, oestrogen levels should be kept stable to avoid triggering an attack. The patch forms of oestrogen supplementation release more smoothly than the oral versions.
Note that migraine is not a risk factor for stroke in post-menopausal women and therefore, HRT is not contraindicated for this reason.
Some women may improve when progesterone is eliminated entirely. However, additional progestogen is necessary to prevent endometrial cancer in unhysterectomised women using oestrogen replacement. This may lead to an increase in migraine, especially if administered cyclically, rather than continuously. A transdermal route of administration can help minimise this effect.