Migraine in perimenopausal women

There is an unmet need for effective diagnosis and management of migraine in perimenopausal women. Menstrual cycle hormone disruption during perimenopause is associated with an increase in migraine and menstrual migraine prevalence, together with other more commonly recognised menopause symptoms. Women of perimenopause age, i.e., early 40s to mid 50s, should routinely be asked about migraine and menopause symptoms, and provided with effective tools for management as appropriate. Simple diaries can be used to identify the frequency and duration of attacks, as well as the relationship to menstruation at outset, and to monitor response to treatment. While there is no evidence to support prescription of hormone replacement therapy (HRT) solely for management of migraine, it is the most commonly used treatment for menopause symptoms. As some types and regimens of HRT can negatively affect migraine, the general recommendation is to use transdermal oestrogen and continuous progestogen regimens where possible. In contrast to contraceptive synthetic oestrogens, physiological doses of natural oestrogen can be used by women with migraine aura. Most women, particularly those with a history of menstrual migraine, can be reassured that the natural history of migraine is to improve with increasing years post menopause.