Headache Treatments
Michael A. Rogawski, M.D., Ph.D.
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  • Menstruation, Pregnancy and Breastfeeding
  • Contraception - Birth Control
  • Menopause - Menopausal Vasomotor Symptoms
  • Butterbur
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  • Neck Pain; Spinal Anatomy & Dermtomes
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  • MIDAS (Migraine Disability Assessment) and ASC-12
  • Botox
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  • Epilepsy/Seizure Drugs in Development
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  • Chronic Pain / Back Pain
  • HIT-6 Headache Impact Test
  • Thunderclap Headache
  • Cerebral Vascular Anatomy
  • Nonpharmacological Measures
  • SphenoCath

Menopausal Vasomotor Symptoms


​​Antidepressants produced modest improvements in vasomotor symptoms.

Venlafaxine and low-dose oral estradiol equally effective in reducing hot flashes (50% vs 30% with placebo)
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Reed SD, LaCroix AZ, Anderson GL, Ensrud KE, Caan B, Carpenter JS, Cohen L, Diem SJ, Freeman EW, Joffe H, Larson JC, McCurry SM, Mitchell CM, Newton KM, Sternfeld B, Guthrie KA. Lights on MsFLASH: a review of contributions. Menopause. 2020 Apr;27(4):473-484.

Transdermal Estrogen/Progestin Combinations

For menopausal vasomotor symptoms. Women with an intact uterus who take a systemic estrogen should also take a progestogen to reduce the risk of endometrial hyperplasia and adenocarcinoma. Progestin should not be used in women who have had uterus removed. Transdermal formulations are as effective as oral estrogens in reducing vasomotor symptoms and may be safer.
 
Climara Pro – Estradiol/levonorgestrel
Estradiol 0.045 mg + levonorgestrel 0.015 mg; per day; transdermal system.
Once per week.
 
CombiPatch – Estradiol/norethindrone
Estradiol 0.05 mg + norethindrone acetate 0.14 mg; per day; transdermal system.
Estradiol 0.05 mg + norethindrone acetate 0.25 mg; per day; transdermal system.
Twice per week.

Climara Pro and CombiPatch are in table below. Note that Climara Pro is once a week.

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PROMETRIUM® (micronized progesterone for oral administration) Prevents Endometrial Hyperplasia

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