Four of every 10 women will experience migraine at some time in their lives, with peak prevalence in middle life. Evidence supports estrogen ‘withdrawal’ as one of the important triggers of menstrual attacks of migraine without aura – “Estrogen replacement and migraine” (Maturitas. 2009 Apr 15).

Abstract

“Four of every 10 women will experience migraine at some time in their lives, with peak prevalence in middle life. Evidence supports estrogen ‘withdrawal’ as one of the important triggers of menstrual attacks of migraine without aura. Improvement of migraine without aura postmenopause is generally attributed to the absence of variations in sex hormone levels. Maintaining a stable estrogen environment is best achieved using non-oral estrogen replacement. Unlike migraine without aura, migraine with aura is recognized as a marker for increased risk of ischemic stroke. Research suggests that aura may be more likely to affect women with underlying coagulation disorders. This could, at least in part, account for both increased risk of stroke and the dose related effect of estrogen replacement on the development of aura. Hence women with migraine with aura requiring estrogen replacement should be given the lowest effective dose necessary to control menopause symptoms, by a non-oral route.” PMID: 19375252

This review states that the lowest effective transdermal route of estradiol should be given for migraine – “Hormonal management of migraine at menopause” (Menopause Int. 2009 Jun;15(2):82-6).

Abstract

“In this review, we underline the importance of linking migraine to reproductive stages for optimal management of such a common disease across the lifespan of women. Menopause has a variable effect on migraine depending on individual vulnerability to neuroendocrine changes induced by estrogen fluctuations and on the length of menopausal transition. Indeed, an association between estrogen ‘milieu’ and attacks of migraine is strongly supported by several lines of evidence. During the perimenopause, it is likely to observe a worsening of migraine, and a tailored hormonal replacement therapy (HRT) to minimize estrogen/progesterone imbalance may be effective. In the natural menopause, women experience a more favorable course of migraine in comparison with those who have surgical menopause. When severe climacteric symptoms are present, postmenopausal women may be treated with continuous HRT. Even tibolone may be useful when analgesic overuse is documented. However, the transdermal route of oestradiol administration in the lowest effective dose should be preferred to avoid potential vascular risk.” PMID: 19465675

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