Migraine across the menopausal transition and beyond: A narrative review - PubMed
6 hours ago
- #menopause
- #hormone-therapy
- #migraine
- Migraine disproportionately affects women, with perimenopause presenting unique diagnostic and therapeutic challenges due to hormonal fluctuations.
- Perimenopausal hormonal instability can worsen migraine frequency and predictability; migraine without aura often improves after menopause, while migraine with aura persists and increases stroke risk.
- Midlife comorbidities such as vasomotor symptoms, sleep disturbances, mood disorders, and metabolic diseases complicate management.
- Hormone therapy effects vary: oral estrogen may worsen migraine and elevate vascular risk, while low-dose transdermal estrogen is safer; continuous progestogen regimens may reduce withdrawal-related attacks.
- Nonhormonal options, including selective norepinephrine reuptake inhibitors for vasomotor symptoms, and traditional migraine therapies (e.g., triptans, NSAIDs) should be tailored for vascular and metabolic health.
- Newer agents like CGRP monoclonal antibodies, gepants, and ditans offer effective alternatives, especially for women with cardiovascular contraindications, but evidence gaps remain regarding menopausal stage or migraine subtype trials.