From the Guidelines
For treating hot flashes in a patient with migraine with aura, gabapentin (300-900 mg daily) is the recommended first-line treatment due to its efficacy in reducing hot flash frequency and severity without increasing stroke risk, as evidenced by studies such as 1. This recommendation is based on the fact that gabapentin has been shown to be at least as effective as other non-hormonal options, such as SSRI/SNRIs, in reducing hot flashes, with a rapid onset of action and minimal side effects, as seen in studies such as 1. Some key points to consider when treating hot flashes in patients with migraine with aura include:
- Non-hormonal options should be considered first due to the increased stroke risk associated with estrogen therapy in these patients.
- Gabapentin (300-900 mg daily) has demonstrated efficacy in reducing hot flash frequency and severity without increasing stroke risk, as shown in 1.
- Other non-hormonal options, such as venlafaxine (75-150 mg daily) and paroxetine (10-25 mg daily), may also be effective, but may have more side effects or interactions, as noted in 1.
- Lifestyle modifications, such as avoiding triggers, dressing in layers, and practicing relaxation techniques, should be implemented concurrently.
- Cognitive behavioral therapy has also shown benefit in reducing hot flash symptoms.
- Hormonal therapy with estrogen should be avoided in migraine with aura patients, as it may increase stroke risk, and if hot flashes are severe and refractory to non-hormonal options, consultation with neurology and gynecology may be warranted to carefully weigh risks and benefits of limited-duration, low-dose hormone therapy with close monitoring.
From the Research
Treatment of Hot Flashes in Patients with Migraine with Aura
- The treatment of hot flashes in patients with migraine with aura requires careful consideration of the potential interactions between the two conditions 2, 3.
- Non-hormonal treatments such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) have been shown to be effective in reducing hot flashes in women with and without a history of breast cancer 4, 5.
- Venlafaxine, an SNRI, has been studied extensively and is consistent in effectively reducing the frequency and severity of hot flashes 4, 5.
- Antidepressants such as amitriptyline and nortriptyline are commonly used as migraine preventives, but their use in patients with hot flashes requires careful consideration of the potential side effects 6.
- Hormone replacement therapy (HRT) may be beneficial in maintaining a stable estrogen environment and relieving vasomotor symptoms, but its use in patients with migraine with aura requires caution due to the potential increased risk of stroke 2, 3.
- The use of physiological doses of natural estrogen and continuous progestogens may minimize the risk of unwanted side effects in patients with migraine with or without aura 3.