Current Treatment Options: Headache Related to Menopause—Diagnosis and Management

  • Clinton G. LauritsenEmail author
  • Abigail L. Chua
  • Stephanie J. Nahas
Headache (JR Couch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


Purpose of review

Menopause is a life-changing event in numerous ways. Many women with migraine hold hope that the transition to the climacteric state will coincide with a cessation or improvement of migraine. This assumption is based mainly on common lay perceptions as well as assertions from many in the healthcare community. Unfortunately, evidence suggests this is far from the rule. Many women turn to a general practitioner or a headache specialist for prognosis and management. A natural instinct is to manipulate the offending agent, but in some cases, this approach backfires, or the concern for adverse events outweighs the desire for a therapeutic trial, and other strategies must be pursued. Our aim was to review the frequency and type of headache syndromes associated with menopause, to review the evidence for specific treatments for headache associated with menopause, and to provide management recommendations and prognostic guidance.

Recent findings

We reviewed both clinic- and population-based studies assessing headache associated with menopause. Headache in menopause is less common than headache at earlier ages but can present a unique challenge. Migraine phenotype predominates, but presentations can vary or be due to secondary causes. Other headache types, such as tension-type headache (TTH) and cluster headache (CH) may also be linked to or altered by hormonal changes. There is a lack of well-defined diagnostic criteria for headache syndromes associated with menopause. Women with surgical menopause often experience a worse course of disease status than those with natural menopause. Hormonal replacement therapy (HRT) often results in worsening of migraine and carries potential for increased cardiovascular and ischemic stroke risk. Estrogen replacement therapy (ERT) in patients with migraine with aura (MA) may increase the risk of ischemic stroke; however, the effect is likely dose-dependent. Some medications used in the prophylaxis of migraine may be useful in ameliorating the vasomotor and mood effects of menopause, including venlafaxine, escitalopram, paroxetine, and gabapentin. Other non-medication strategies such as acupuncture, vitamin E, black cohosh, aerobic exercise, and yoga may also be helpful in reducing headache and/or vasomotor symptoms associated with menopause.


The frequency and type of headache associated with menopause is variable, though migraine and TTH are most common. Women may experience a worsening, an improvement, or no change in headache during the menopausal transition. Treatment may be limited by vascular risks or other medical and psychiatric factors. We recommend using medications with dual benefit for migraine and vasomotor symptoms including venlafaxine, escitalopram, paroxetine, and gabapentin, as well as non-medication strategies such as acupuncture, vitamin E, black cohosh, aerobic exercise, and yoga.

If HRT is pursued, continuous (rather than cyclical) physiological doses should be used, transdermal route of administration is recommended, and the patient should be counseled on the potential for increased risk of adverse events (AEs). Concomitant use of a progestogen decreases the risk of endometrial hyperplasia with ERT. Biological mechanisms are incompletely understood, and there is a lack of consensus on how to define and classify headache in menopause. Further research to focus on pathophysiology and nuanced management is desired.


Migraine Headache Menopause Estrogen Hormone replacement therapy Contraceptive 



cluster headache


tension-type headache


follicle-stimulating hormone


luteinizing hormone


final menstrual period


vasomotor symptoms


age at natural menopause


menstrually related migraine


pure menstrual migraine


hormone replacement therapy


American Migraine Prevalence and Prevention Study


Hospital Anxiety and Depression Scale


migraine disability assessment scores


Study on Women’s Health Across the Nation


episodic tension-type headache


migraine without aura


migraine with aura


medroxyprogesterone acetate


levonorgestrel-releasing intrauterine system


estrogen replacement therapy


cerebral sinus thrombosis


combined hormonal contraceptive


double-blind placebo-controlled


Menopause Rating Scale


Menopause-Specific Quality of Life questionnaire


Sao Paulo Epidemiologic Sleep Study


nocturnal awakening with headache


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Clinton G. Lauritsen
    • 1
    Email author
  • Abigail L. Chua
    • 2
  • Stephanie J. Nahas
    • 1
  1. 1.Department of NeurologyThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Hartford Healthcare Headache CenterWest HartfordUSA

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