The prevalence of migraine peaks during the 40s and an increased association between migraine and menstruation is often noted. Migraine generally improves after the menopause. Although menstrual irregularity, hot flushes and other climacteric symptoms may warrant management with hormone replacement therapy (HRT), there has been some concern that HRT may aggravate migraine and potentially increase the risk of ischaemic stroke. This evidence-based review concludes that migraine is not a contraindication for HRT but continuous-release transdermal estrogen, in the lowest effective dose, is recommended.
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