For most women, headaches are a relatively minor problem. Some women, however, experience headaches so severe their quality of life becomes greatly affected. When women reach perimenopause, hormonal fluctuations that occur can cause the onset of headaches or cause existing headache to increase in severity.
Along with the hormonal fluctuation, there are many other “triggers” that can cause migraine headaches in perimenopausal women:
Research studies have shown that the fluctuations of estrogen levels due to perimenopause can also increase the prevalence as well as the intensity of headaches. Women who have a history of headaches during menstruation find that during perimenopause their headaches worsen. For these women, two thirds will experience relief from their migraines after menopause.
If you are experiencing headaches, keeping a diary for a few weeks will help identify the triggers. You should keep track of the time, symptoms, and any possible contributing factor such as food, noise or stress. By identifying the pattern you can determine the best measures to take for preventing the headache from reoccurring. Pay particular attention to the hormonal changes you may be experiencing such as menses to see if these hormonal changes affect the severity or onset of your headache.
The role of hormone therapy in headache management is unclear. Hormone replacement therapy (HT) and oral contraceptives (OC’s) have been helpful in some women with hormone-related headaches.
If you find that estrogen replacement therapy (ERT)/HT or oral contraceptives exacerbate your migraines, discontinue use. In this case, using estradiol instead of other estrogens may be helpful. Sometimes a woman on oral contraceptives develops migraines during the placebo week. In this case a low dose estrogen patch can be used for that week.
Use caution when prescribing OC’s or ERT/HT for women who experience migraines with aura. Studies suggest that women with aura have an increased risk of stroke, hormone therapy may add to that risk. Progestogens may actually aggravate or precipitate headaches. If headaches are worsening with medroxy-progesterone acetate, a change to micronized progesterone may help. Continuous regimens of HT may provide greater hormonal stability than cyclic HT and therefore may reduce the incidence of headaches by smoothing out hormonal fluctuations. A trial of weeks to months of HT may be required before improvement is seen.
Management of Headaches
Source: NAMS (Margaret F. Moloney, RN-C, PhD, ANP) The Female Patient Vol. 27 April 2002
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