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Migraines During and After Menopause
Posted June 2000

Typically, migraines worsen during menopause, but then may improve afterward. Yet it is not uncommon to have a different experience: some women get worse headaches after menopause; others enjoy a complete cessation of head pain. Some women who have never had a headache problem get severe migraines for the first time during menopause. Still other women experience no change in their migraine patterns.

If possible, doctors generally minimize hormone replacement in migraine treatment. Although hormones seem to help some women, they worsen headaches more often than help them. For many women, hormones don’t affect the headaches one way or another. If you take hormones for other reasons and want to reap the benefits of these hormones, talk to your doctor about whether they seem to affect your headaches. If your headaches become severe after taking hormones, it may be necessary to stop taking them.

Which hormones you take and how you use them can influence your headaches. In general, the natural estrogens, such as Premarin, tend to aggravate headaches more than the "synthetic estrogens," such as Estinyl and Estrace, do. The hormone patch, which delivers a smooth, controlled amount of estrogen, sometimes leads to fewer headaches. If you haven’t had a hysterectomy, progestins (progesterone, such as Provera), along with the estrogen, are usually necessary. There are tablets that contain a combination of estrogen plus progesterone. Progestins often exacerbate headaches, and doctors prefer to minimize the progesterone. After a hysterectomy, the primary use of progestins (to prevent uterine cancer) is no longer necessary. Thus, after a hysterectomy, doctors often skip the progesterone.

Ideally, estrogens that are used continuously (noncycling) are better for headaches. When the estrogen is stopped for one week, the dip in estrogen levels may increase headaches. However, by using continuous estrogen, the risk for breast or uterine cancer may be slightly increased. After a hysterectomy, women are often placed on continuous estrogen without a break.

The "as-needed" and preventive medications basically remain the same during and after menopause. However as you get older, you become at higher risk for cardiac (heart) problems, and so doctors may recommend that you abstain from using the triptans (Imitrex, Amerge, Maxalt, Zomig, Relpax). Ergotamines are rarely used after age fifty. As for preventive medication, weight gain is often a major problem during these years. Searching for preventive medication that does not exacerbate or cause weight gain is important. The preventive medications that tend to minimize weight gain include NSAIDs, calcium blockers, and select antidepressants, such as Vivactil, Prozac, Zoloft, Paxil, Celexa, Wellbutrin and Effexor.