Migraine, the menopause and hormone replacement therapy: a clinical review.

In contrast to the relatively stable hormone profile during the middle reproductive years, the perimenopause is marked by erratic fluctuations of oestrogen and progesterone. By the late perimenopause, oestrogen levels can reach high magnitudes.1 Given the association between migraine and oestrogen ‘withdrawal’ it is not surprising that this stage of life is often accompanied by worsening migraine, which persists until oestrogen levels plateau post-menopause. This paper reviews the effects that menopause and hormone replacement therapy (HRT) have on headache and migraine and considers the data on the risk of ischaemic stroke in HRT users with migraine. This evidence will be used to support practical guidance on the management of women with migraine wishing to use HRT.