title: Hormonal management of migraine at menopause.
abstract: 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.
authors.affiliation: Department of Morphological, Etiological and Clinical Sciences, Research Center of Reproductive Medicine, University of Pavia, Via Ferrata 8, 27100 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: Silvia
authors.initials: S
authors.lastname: Detaddei
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ornati
authors.forename: Luca
authors.initials: L
authors.lastname: Chiovato
authors.forename: Franco
authors.initials: F
authors.lastname: Polatti
mesh_terms: D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006304:Health Status; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D016896:Treatment Outcome; D016387:Women's Health
chemical_list: D004967:Estrogens