Systemic MHT in individuals with migraine

Hormonally sensitive migraine may worsen during perimenopause, when estrogen concentrations fluctuate widely, and may improve after menopause, when estrogen concentrations are stable, albeit low. Other factors or menopausal symptoms (eg hot flushes, lack of sleep) may also contribute to migraine during perimenopause or menopause.

All types of migraine may be associated with an increased risk of stroke. The association is much weaker in individuals who do not experience an aura.

For individuals with any type of migraine who need systemic MHT, transdermal formulations are preferred because they have a lower risk of VTE and cardiovascular disease than oral formulations. If a progestogen is needed, continuous combined MHT may be associated with fewer migraine episodes compared to cyclical combined MHT.

If aura symptoms or headache become more intense or prolonged when taking MHT, stop the therapy. Clonidine is a useful nonhormonal alternative to treat hot flushes because it can also prevent migraine.