Migraine

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Fluctuating oestrogen levels during the menopause transition are associated with increased migraine prevalence.
Where HRT is prescribed, a form that minimises hormone fluctuations is preferable. Stable oestrogen levels are best achieved using non-oral routes of oestrogen administration.
Migraine with aura does not contraindicate HRT use. However, transdermal oestrogen preparations should be used.
The lowest oestrogen dose required to control symptoms should be prescribed.
Sequential progestogens can have an adverse effect on migraine and where possible continuous progestogens are preferred. Options include a 52mg levonorgestrel intrauterine system (52mg LNG-IUD), continuous combination patches or continuous micronised progesterone. If a continuous progestogen is not suitable, a sequential progestogen regime can still be tried.
Body identical progesterone, known as micronised progesterone, has the advantage of being sedating when taken by mouth in some individuals. Where sleep deprivation is a migraine trigger this can be helpful.

NOTE:

Transdermal oestrogen can be safely prescribed in women with migraine with aura.
Low HRT doses should be initiated in women with migraine and titrated slowly to avoid fluctuations.
Menopause and HRT can effect migraines. If in doubt refer to a menopause specialist.

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