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HRT and Migraines

Checked: 09-12-2024 by Vicky Ryan Next Review: 08-12-2026

HRT and migraines

For women experiencing migraine, transdermal estrogens should be used.  

Migraines are often triggered by fluctuation in hormone levels. A patch provides a stable release of hormones and therefore is the preferred option. 

Use the lowest dose of estrogen that controls vasomotor symptoms. Start with a low dose and increase gradually if required.   

Where progestogen is required, continuous delivery is recommended, with preparations such as: 52mg levonorgestrel intrauterine device, transdermal norethisterone (as in combined patches), micronised progesterone.  

The BMS has produced helpful guidance on HRT prescribing in people with migraine available here: 06-BMS-TfC-Migraine-and-HRT-NOV2022-A.pdf (thebms.org.uk) 

Resources

18-WHC-FACTSHEET-Migraine-and-HRT-NOV2023-B.pdf (womens-health-concern.org) 

Migraine, menopause and HRT - National Migraine Centre 

Headaches, migraines and the menopause explained - a British Menopause Society video (youtube.com)



Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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