Hormone replacement therapy (HRT) can potentially trigger or worsen migraines in some people. This seems to occur more often in those with a history of migraine headaches, especially migraine with aura.
The exact mechanism behind how HRT may trigger migraines is not fully understood. Some theories include:
- Estrogen fluctuations during HRT can trigger migraines in susceptible individuals, similar to how hormonal fluctuations during the menstrual cycle can trigger menstrual migraines. The drop in estrogen right before the next HRT dose may play a role.
- The progesterone component of HRT may trigger migraines in some people.
- HRT medications contain forms of hormones that are different than what the body naturally produces. These may interact with migraine pathways in the brain.
Who is most at risk:
- Women with a history of menstrual migraines or migraines related to menopause/perimenopause seem more likely to get migraines from HRT.
- Those with a history of migraine with aura are more likely to get migraines from HRT than those with migraine without aura.
- Risk may be higher if you have started getting migraines or increased migraine frequency around perimenopause.
Strategies to reduce migraine trigger from HRT:
- Start with low dose estrogen and see if that triggers migraines before increasing dose.
- Take the progesterone only on a scheduled basis rather than daily.
- Use transdermal estrogen delivery (patch, gel) rather than oral estrogen. This creates more stable estrogen levels compared to the peaks and valleys with pills.
- Take migraine preventative medications like topiramate or propranolol while on HRT. Work with your doctor on this.
- Natural progesterone creams may be less likely to trigger migraines than synthetic progestins used in traditional HRT.
- Bioidentical hormone therapy prepared by a specialty compounding pharmacy may help in some cases. The hormones are identical in structure to hormones naturally produced and may be more physiologic.
If you develop migraines on HRT:
- Notify your doctor promptly to review options
- Be prepared to try lower doses, different delivery methods, natural hormones, and preventatives
- In some cases, stopping HRT altogether ends up being necessary if debilitating migraines develop