Migraine and Menopause
Migraine tends to worsen on the years leading into and during the menopause. Attacks can occur more frequently and sometimes last longer. Many women notice more of a link with their periods, and intuitively know that their hormones are changing. Periods can also become erratic and more frequent, which also means more migraines.
The main reason for worsening migraine during menopause is the fluctuation of oestrogen. Periods themselves can become more troublesome, with more pain and heavier bleeding, usually indicating insufficient amounts of progesterone or indeed an over production of oestrogen. Both of these scenarios can make migraine more likely.
As periods lessen, so the hormonal fluctuations that trigger for migraine also lessens, which is why many women find migraine improves after the menopause. However, it may take a few years after your last period before migraine improves again. During this time, your body is re-adjusting to a new physiological environment without the hormonal balance that was present prior to the menopause. This is usually just one or two years, although some women find that they still get hot flushes and migraine many years after the menopause.
Hormone replacement therapy (HRT), and in particular Bio-identical or bio-equivalent forms of HRT, or BHRT, is very effective at controlling menopause symptoms, and, it can also help reduce the likelihood of migraine by reducing the fluctuating oestrogen levels. However, some forms of BHRT can create more hormone fluctuations, thereby triggering migraine. This is most likely to occur with tablets of BHRT.
It is generally recommended that women with migraine who need BHRT should use estrogen patches or gel, as these maintain stable hormone levels with few fluctuations. These also have the benefit of providing hormones in the form of body-identical (or bio-identical) estrogen.
Body-identical or (bio-identical) progesterone is available separately as tablets of micronized bioidentical progesterone or as a non-bioidentical progestin in the form of an intrauterine coil called the Mirena, which works locally within the womb.
Unlike the combined oral contraceptive pill, which is contraindicated for women with migraine aura, BHRT uses natural estrogen producing similar levels to the estrogen produced by your body during your menstrual cycle. If aura worsens or starts for the first time with BHRT, it usually means that the dose of estrogen is either too little or more than you need.
What if I can’t take estrogen? There are very few women who are advised not to take bio-identical estrogen. These include women with a history breast cancer. If you are overweight, weight loss can benefit both migraine and menopause symptoms. Regular exercise has also been shown to be effective. Non-hormonal alternatives include escitalopram or venlafaxine. These drugs act on the chemical messenger serotonin, which is implicated in both migraine and hot flushes.