Menopause International > Volume 15, Number 2 > Pp. 82-86

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Nappi, R. E Articles by Polatti, F. PubMed PubMed Citation Social Bookmarking                      What's this?

Reviews

Hormonal management of migraine at menopause

Rossella E Nappi ^*   , Grazia Sances  , Silvia Detaddei  , Alessandra Ornati ^* , Luca Chiovato  and Franco Polatti ^*

^* Department of Morphological, Etiological and Clinical Sciences, Research Center of Reproductive Medicine, University of Pavia, Pavia, Italy
Unit of Gynecological Endocrinology and Menopause, Department of Internal Medicine & Endocrinology, IRCCS Maugeri Foundation, University of Pavia, Pavia, Italy
University Center of Adaptive Disorders and Headache (UCADH), University of Pavia, Pavia, Italy
Department of Neurology, Headache Centre, IRCCS ‘C. Mondino Foundation’, Pavia, Italy

Correspondence: Rossella E Nappi MD PhD, Research Center of Reproductive Medicine, Unit of Gynecological Endocrinology and Menopause, IRCCS Maugeri Foundation, University of Pavia, Via Ferrata 8, 27100 Pavia, Italy. Email: renappi{at}tin.it
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 favourable 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.

Key Words: Climacteric • headache • estrogen • progestin • tibolone

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?