title: Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches.
abstract: 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.
authors.affiliation: Research Center for Reproductive Medicine, University of Pavia, Pavia, Italy. renappi@tin.it
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.forename: Grazia
authors.initials: G
authors.lastname: Sances
authors.forename: Arianna
authors.initials: A
authors.lastname: Sommacal
authors.forename: Silvia
authors.initials: S
authors.lastname: Detaddei
authors.forename: Fabio
authors.initials: F
authors.lastname: Facchinetti
authors.forename: Silvano
authors.initials: S
authors.lastname: Cristina
authors.forename: Franco
authors.initials: F
authors.lastname: Polatti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nappi
mesh_terms: 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
chemical_list: D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; C027385:tibolone