etting older is also usually associated with both headaches and associated symptoms becoming less severe so it may not be only menopause, but also aging, which produces headache improvement in many cases.

Migraine as a result of hormone fluctuations is sometimes associated with perimenopause. In addition, irregular menses can make management of the condition less predictable. The plasma levels of sex steroids decline as menopause progresses, and migraine frequently abates.

This suggests that some factors other than hormones contribute to the predominance of migraine in women, but the reasons for this are not well understood.

If attacks linked to irregular menses or other perimenopausal symptoms are apparent, HRT(Hormone Replacement Therapy) may be considered as an option, provided that there are no contraindications to its use.

HRT is licensed for the control of menopausal symptoms and the prevention of osteoporosis and has a variable effect on migraine frequency. Research as shown that it is almost a likely to worsen migraine than improve it. It remains virtually impossible to predict what a given woman will experience.

Some women may improve when progesterone is eliminated entirely. However, additional progestogen is necessary to prevent endometrial cancer in unhysterectomised women using oestrogen replacement. This may lead to an increase in migraine, especially if administered cyclically, rather than continuously. A transdermal route of administration can help minimise this effect.