3 HRT Questions When You Have Migraine

If headaches already make you cancel plans, you may worry that a menopause prescription will add another reason to stay home. Bring the migraine history into the prescribing discussion before deciding what to try.

Three prescribing questions

1. Does my history include aura? Explain any visual, sensory or speech symptoms around attacks. Combined hormonal contraception is contraindicated with migraine aura, while HRT may still be considered. Ask the prescriber to explain the distinction and your individual risks.¹²
2. Is the aim menopause symptom treatment or hormone cycle control? During perimenopause, estrogen fluctuations can drive migraine. Conventional HRT and methods that suppress ovarian activity have different roles. Ask which goal fits your symptoms at this stage.¹
3. Which route, dose and review plan fit me? When HRT is needed after menopause, transdermal estrogen is generally preferred for migraine, at the lowest dose that controls menopause symptoms. Seek prescriber advice for new or worsening aura after starting HRT.¹²

Bring the dates as well as the description

A headache and menstrual diary can help identify patterns and assess treatment effects. Record attacks and changes after any agreed treatment adjustment.¹

Ask when to review the plan and who to contact if the headache pattern changes. Keep the answers with the medicine instructions so the next step is easy to find.

A sudden, extremely painful headache, new one-sided weakness, difficulty speaking, or vision loss needs emergency assessment. Call 911 or your local emergency number.³

My Body Changed. Now What? includes a symptom diary and VisitBrief. Use them to organize your observations and prescribing questions. See the book.