How can migraine during perimenopause be treated?


Hormone treatment, particularly low-dose estrogen, can be used to treat migraine and help a woman ease into perimenopause. Another option is the use of antidepressants.


“So there's a number of different treatment options depending on that woman, but we are increasingly using hormones in this age group. Even very low-dose birth control pills. And just to give an idea, birth control pills used to be like 50 and 80 mcg of estrogen. And that's when you would hear concerns about migraine, stroke risk, and health concerns. But we now have birth control pills as low as 10 mcg of estrogen … There's one called Lo Loestrin. And so there's nice ways of using very, very low-dose birth control pills to help a woman ease into perimenopause. Not just to help with the headaches, but the hot flashes, the night sweats, the insomnia. But there's other things too. As you probably know, there's traditional migraine preventive treatments. And one class of migraine preventives are the anti-depressants. Some just work on serotonin, like fluoxetine, which is Prozac. Some work on serotonin and norepinephrine. Like, there's one called Effexor, there's one called Cymbalta. Those can help, not just prevent migraine, those can help hot flashes and night sweats.”


Doctors increasingly are using hormone treatment, particularly very low-dose estrogen, to help a woman ease into perimenopause and help alleviate migraine attacks. In addition to traditional migraine preventive treatments, antidepressants can be another option.

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Susan Hutchinson, MD

Author - The Women's Guide to Managing Migraine
Orange County Migraine & Headache Center

Dr. Susan Hutchinson is a headache specialist and board-certified family practice physician. In February 2007, she founded Orange County Migraine & Headache Center, dedicated to serving patients with headache and mood disorders. Although she is not a psychiatrist, she has developed a special interest in treating mood disorders as well as headache. The mood disorders she treats include depression; anxiety; bipolar disorder; ADHD; and panic attacks. Dr. Hutchinson suffers from migraine headaches which gives her an empathy with her patients.

She felt such a calling to help patients with headache and mood disorders that she decided to specialize and devote her career to alleviating the suffering caused by both headaches and mood disorders. She lectures nationally on the subject of headache; has written dozens of articles for medical journals; participated in headache research projects and is very active in numerous professional organizations such as the American Headache Society and the National Headache Foundation.

She is the immediate post-chair of the Women’s Issues section of the American Headache Society after serving in the chair position for 5 years. Dr. Hutchinson is a dynamic and sought-after speaker. She speaks for community groups as well as professional groups. In 2010 she became the President of The Orange County Chapter of the California Academy of Family Physicians.