Headache at menopause and in hormone replacement therapy users

To determine the prevalence of headache in menopausal women and to assess factors that may influence headache at menopause and in women using hormone replacement therapy (HRT).

A questionnaire survey was performed on 1000 consecutive women attending Leicester Royal Infirmary menopause clinics. Weight, blood pressure and smoking status were also recorded.

Recurrent headache was common and reported by 850 women; 240 women reported a history of migraine. Most women (n = 617) had headaches more frequently than once monthly and 520 women had had at least one headache in the preceding week. Stress was the most common trigger factor (n = 704). A group of 'hormone-sensitive' women was identified (n = 259) whose headaches became worse at menopause and showed variable response to HRT. Logistic regression models showed reported history of migraine and more difficulty coping with stress to be strong predictors for worse headache at menopause and with HRT. Headache improved with age and increasing diastolic blood pressure. No other significant factors were identified.

Headache is a substantial problem at menopause and in HRT users. It is difficult to predict which women will develop worse headaches at menopause and with HRT, but a history of migraine and reduced coping with stress were significant factors in this group.