Your postmenopausal patient reports a history of migraine
Would a trial of hormone therapy increase her risk of stroke?
My bottom line
No systematic data on the use of HT in migraineurs has been published. In the absence of such data, some practitioners have extrapolated data on the use of OCs in this population and decline to prescribe HT to women with migraine. However, HT and OCs are vastly different in formulation, dose, and risks. Rather than make assumptions on the basis of irrelevant data, we should conduct studies of HT use in migraineurs.
Related article: Update on Menopause Andrew M. Kaunitz, MD (June 2013)
Women who have menstrually related migraine typically have an increased risk of migraine during perimenopause and a significant reduction in migraine following menopause. If hot flashes are bothersome, these women certainly can use HT. I recommend prescribing HT in a continuous fashion that maintains stable hormone levels in the blood, as fluctuating hormones tend to trigger migraines.
Andrew M. Kaunitz, MD:
I would just add that transdermal estradiol is preferred, to be given at the lowest effective dose.
Do you have a troubling case in menopause? Suggest it to the expert panel: obg@frontlinemedcom.com. They may address your management dilemma in a future issue.
We want to hear from you! Send us your Letter to the Editor
