Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches.
OBJECTIVE
The present randomized prospective study aimed to compare the effect of tibolone (T) with conventional low-dose estrogen-progestogen therapy (EPT) administered in a combined continuous regimen on the course of primary headaches in postmenopausal women requesting hormone therapy (HT) for climacteric complaints.


METHODS
Forty women presenting for clinical evaluation of headache (migraine without aura and episodic tension-type headache) were enrolled. The observational period lasted 7 months during which women kept a diary of the clinical characteristics of headache attacks and analgesic use. Climacteric symptoms and both anxiety and depression were also measured. After a 1-month run-in period, women received two different HT regimens: 1 mg 17beta-estradiol + 0.5 mg norethisterone acetate (EPT) or 2.5 mg T. Follow-up evaluations were planned after 3 and 6 months of treatment.


RESULTS
Although T did not affect the number of days with migraine without aura, it significantly reduced the number of hours during which pain intensity prohibited daily activities (P < 0.001) and the number of analgesics (P < 0.001) after 3 months. Conventional low-dose EPT administered in a combined continuous regimen was confirmed to have a mild, but negative, effect on the course of migraine without aura by increasing the number of days with head pain (P < 0.001) and the number of analgesics (P < 0.001). Interestingly, both treatments were effective in the management of episodic tension-type headache, significantly reducing the number of days with head pain, severity, and analgesic consumption.


CONCLUSIONS
In postmenopausal headache sufferers, analgesics are more effective in alleviating severe head pain when women are treated with T in comparison with low-dose EPT for climacteric complaints.
Nappi
Rossella E
RE
Research Center for Reproductive Medicine, University of Pavia, Pavia, Italy. renappi@tin.it
Sances
Grazia
G
Sommacal
Arianna
A
Detaddei
Silvia
S
Facchinetti
Fabio
F
Cristina
Silvano
S
Polatti
Franco
F
Nappi
Giuseppe
G
D000704:Analysis of Variance; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage / Q000494:pharmacology*; D015914:Estrogen Replacement Therapy; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009652:Norpregnenes / Q000008:administration & dosage / Q000494:pharmacology*; D017698:Postmenopause / Q000187:drug effects; D011446:Prospective Studies
D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; C027385:tibolone