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Hormonal Management of Migraine Associated With Menses and the Menopause: A Clinical Review
Article first published online: 13 FEB 2007
Headache: The Journal of Head and Face Pain
Volume 47, Issue 2, pages 329–340, February 2007
How to Cite
Loder, E., Rizzoli, P. and Golub, J. (2007), Hormonal Management of Migraine Associated With Menses and the Menopause: A Clinical Review. Headache: The Journal of Head and Face Pain, 47: 329–340. doi: 10.1111/j.1526-4610.2006.00710.x
From the Departments of Neurology (Division of Headache and Pain) (Drs. Loder and Rizzoli); and Obstetrics and Gynecology (Dr. Golub); Harvard Medical School, Boston, MA, USA; John R. Graham Headache Centre (Drs. Loder and Rizzoli) Brigham and Women's (Drs. Loder, Rizzoli, and Golub); and Faulkner Hospitals, Boston, MA, USA (Drs. Loder and Rizzoli).
Accepted for publication November 20, 2006.
- Issue published online: 13 FEB 2007
- Article first published online: 13 FEB 2007
Objective.—This article reviews hormonal strategies used to treat headaches attributed to the menstrual cycle or to peri- or postmenopausal estrogen fluctuations. These may occur as a result of natural ovarian cycles, or in response to the withdrawal of exogenously administered estrogen.
Background.—A wide variety of evidence indicates that cyclic ovarian sex steroid production affects the clinical expression of migraine. This has led to interest in the use of hormonal treatments for migraine.
Methods.—A PubMed search of the literature was conducted using the terms “migraine,”“treatment,”“estrogen,”“hormones,”“menopause,“ and “menstrual migraine.” Articles were selected on the basis of relevance.
Results.—The overarching goal of hormonal treatment regimens for migraine is minimization of estrogen fluctuations. For migraine associated with the menstrual cycle, supplemental estrogen may be administered in the late luteal phase of the natural menstrual cycle or during the pill-free week of traditional combination oral contraceptives. Modified contraceptive regimens may be used that extend the duration of active hormone use, minimize the duration or extent of hormone withdrawal, or both. In menopause, hormonally associated migraine is most likely to be due to estrogen-replacement regimens, and treatment generally involves manipulating these regimens. Evidence regarding the safety and efficacy of these regimens is limited.
Conclusions.—Hormonal treatment of migraine is not a first-line treatment strategy for most women with migraine. Evidence is lacking regarding its long term harms and migraine is a contraindication to the use of exogenous estrogen in all women with aura and those aged 35 or older. The harm to benefit balances of several traditional nonhormonal therapies are better established.