Hormonal management of migraine at menopause

Rossella E. Nappi, Grazia Sances, Silvia Detaddei, Alessandra Ornati, Luca Chiovato, Franco Polatti

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)82-86
Number of pages5
JournalJournal of the British Menopause Society
Issue number2
Publication statusPublished - Jun 2009


  • Climacteric
  • Estrogen
  • Headache
  • Progestin
  • Tibolone

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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