PMID- 29508091
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 1092-8480 (Print)
IS  - 1092-8480 (Linking)
VI  - 20
IP  - 4
DP  - 2018 Mar 6
TI  - Current Treatment Options: Headache Related to Menopause-Diagnosis and 
      Management.
PG  - 7
LID - 10.1007/s11940-018-0492-7 [doi]
AB  - 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.
FAU - Lauritsen, Clinton G
AU  - Lauritsen CG
AD  - Department of Neurology, Thomas Jefferson University, 900 Walnut St. Suite 200, 
      Philadelphia, PA, 19107, USA. Clinton.Lauritsen@jefferson.edu.
FAU - Chua, Abigail L
AU  - Chua AL
AD  - Hartford Healthcare Headache Center, 65 Memorial Road Suite 508, West Hartford, 
      CT, 06109, USA.
FAU - Nahas, Stephanie J
AU  - Nahas SJ
AD  - Department of Neurology, Thomas Jefferson University, 900 Walnut St. Suite 200, 
      Philadelphia, PA, 19107, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180306
PL  - United States
TA  - Curr Treat Options Neurol
JT  - Current treatment options in neurology
JID - 9815940
OTO - NOTNLM
OT  - Contraceptive
OT  - Estrogen
OT  - Headache
OT  - Hormone replacement therapy
OT  - Menopause
OT  - Migraine
EDAT- 2018/03/07 06:00
MHDA- 2018/03/07 06:01
CRDT- 2018/03/07 06:00
PHST- 2018/03/07 06:00 [entrez]
PHST- 2018/03/07 06:00 [pubmed]
PHST- 2018/03/07 06:01 [medline]
AID - 10.1007/s11940-018-0492-7 [pii]
AID - 10.1007/s11940-018-0492-7 [doi]
PST - epublish
SO  - Curr Treat Options Neurol. 2018 Mar 6;20(4):7. doi: 10.1007/s11940-018-0492-7.