Course of primary headaches during hormone replacement therapy

Objective: The aim of the present study was to evaluate how hormone replace ment therapy (HRT) could influence the course of primary headaches in postm enopausal women. Methods: Fifty patients presenting for clinical evaluation of menopausal status and suffering from headache were enrolled. The observ ational period lasted 7 months during which women filled in a diary with th e clinical characteristics of headache attacks (frequency, days with headac he, severity) and the analgesic use (no. of analgesic/month). Climacteric s ymptoms and both anxiety and depression were also measured. At the first vi sit the patients were divided into two groups: those suffering from migrain e without aura (MwA) and those suffering from episodic tension-type headach e (ETTH) and separately randomized. After a mouth of run-in period, they re ceived two different HRT regiment either: (1) transdermal estradiol 50 meg every 7 days for 28 days plus medroxyprogesterone acetate (MAP) 10 mg/day f rom 15th to 28th day, or (?) oral conjugated estrogens 0.625 mg/day for 28 days plus MAP 10 mg/day for the last 14 days. Follow up evaluations were pl anned after 1, 3 and 6 months of treatment. Results: While we did not obser ve ay significance change regarding headache parameters in ETTH patients du ring both transdermal and oral treatment, the course of migraine was signif icantly affected by the route of HRT. Both frequency of attacks (F = 8.5; P < 0.000) and days with headache (F = 6.9; P < 0.000) significantly increas ed during HRT in the subgroup assuming oral formulation. On the contrary, n o changes in the same parameters were found in the group taking transdermal treatment. Moreover. while severity of migraine was unaffected by HRT, ana lgesic consumption was significantly increased in the subgroup on oral trea tment (F = 6.3; P = 0.001)). Conclusions: HRT significantly affects the cou rse of headache in postmenopausal migraine sufferers. Indeed, while the cli nical pattern of ETTH remained stable throughout the observational period, patients suffering from MwA worsened their symptoms within the first 3 mont hs of treatment. In particular, the oral, route of administration significa ntly worsened migraine in comparison to the transdermal route. (C) 2001 Els evier Science ireland Ltd. All rights reserved.