Current Treatment Options: Headache Related to Menopause—Diagnosis and Management

Abstract

We reviewed both clinic- and population-based studies assessing headache associated with menopause. Headache in menopause is less common than headache at earlier ages but can present a unique challenge. Migraine phenotype predominates, but presentations can vary or be due to secondary causes. Other headache types, such as tension-type headache (TTH) and cluster headache (CH) may also be linked to or altered by hormonal changes. There is a lack of well-defined diagnostic criteria for headache syndromes associated with menopause. Women with surgical menopause often experience a worse course of disease status than those with natural menopause. Hormonal replacement therapy (HRT) often results in worsening of migraine and carries potential for increased cardiovascular and ischemic stroke risk. Estrogen replacement therapy (ERT) in patients with migraine with aura (MA) may increase the risk of ischemic stroke; however, the effect is likely dose-dependent. Some medications used in the prophylaxis of migraine may be useful in ameliorating the vasomotor and mood effects of menopause, including venlafaxine, escitalopram, paroxetine, and gabapentin. Other non-medication strategies such as acupuncture, vitamin E, black cohosh, aerobic exercise, and yoga may also be helpful in reducing headache and/or vasomotor symptoms associated with menopause. The frequency and type of headache associated with menopause is variable, though migraine and TTH are most common. Women may experience a worsening, an improvement, or no change in headache during the menopausal transition. Treatment may be limited by vascular risks or other medical and psychiatric factors. We recommend using medications with dual benefit for migraine and vasomotor symptoms including venlafaxine, escitalopram, paroxetine, and gabapentin, as well as non-medication strategies such as acupuncture, vitamin E, black cohosh, aerobic exercise, and yoga. If HRT is pursued, continuous (rather than cyclical) physiological doses should be used, transdermal route of administration is recommended, and the patient should be counseled on the potential for increased risk of adverse events (AEs). Concomitant use of a progestogen decreases the risk of endometrial hyperplasia with ERT. Biological mechanisms are incompletely understood, and there is a lack of consensus on how to define and classify headache in menopause. Further research to focus on pathophysiology and nuanced management is desired.

Generic MS-based method for the bioanalysis of therapeutic monoclonal antibodies in nonclinical studies

“…Moreover, the bioanalysis of rituximab and trastuzumab have been generally performed with the LBA method; for these reasons, the criteria (≤20% [LLOQ: ≤25%]) in the guideline on bioanalysis by the LBA method were adopted as the criteria of our method validation [24]. However, in our collaborative study, four laboratories achieved accuracy and precision values below the acceptance criteria (accuracy, 100 ± 15% [LLOQ: ±20%]; precision, ≤15% [LLOQ: ≤20%]) for the bioanalysis of small molecules using a chromatographic method [25]. Discussion on the acceptance criteria for MS-based bioanalysis of large molecules is still ongoing in the bioanalytical community, and the criteria have not been clearly established in any guideline/guidance.…”

Resultados y seguimiento de la rehabilitación vestibular

“…La introducción en la Clasificación Internacional de Alteraciones Vestibulares de la Sociedad Bárány de los criterios diagnósticos del denominado PPPD (persistent postural-perceptual dizziness) [15] y los estudios piloto realizados, demuestran que un 78 % de los pacientes afectados (que corresponde a un 8-10% de los que se reciben con mareo en un centro neurotológico especializado), experimentan una reducción mantenida en el tiempo (> 1 año) de su mareo, con la combinación de medicación antidepresiva, terapia cognitiva del comportamiento y RV [16][17]. Finalmente, aunque aún son necesarios más estudios controlados, va creciendo el convencimiento de que la RV puede ser útil como tratamiento coadyuvante en la migraña vestibular, donde a pesar de su frecuencia, todavía no existe un consenso terapéutico [18][19][20].…”

Management Strategies of The Symptomatology and Pathology Associated with Menopause – An Overview

“…More and more menopausal women refer to a specialist for appropriate treatment in order to improve headache and migraines [31]. Natural menopause improves the severity and frequency of migraines, while surgically induced menopause, does not.…”