Estrogen and Migraine: Correlations and Prevention


E. Anne MacGregor, Director of Clinical Research, The City of London Migraine Clinic, 22 Charterhouse Square, London, EC1M 6DX, UK.


Migraine is a neurovascular condition that is influenced by the hormonal milieu. The risk of a migraine attack is increased among women migraineurs during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation. Evidence suggests that the increased risk results from estrogen withdrawal in the concurrent late luteal/early follicular phase. For some women with menstrual migraine, headaches that occur at this time are more severe, are of longer duration, and are more disabling. If patients have regular menses, short-term prevention strategies may provide relief for women whose headaches are not responsive to acute treatment. Clinical trials designed to assess short-term prevention with estrogen supplements and with triptans have demonstrated efficacy in this setting and have provided new insights into the mechanisms underlying menstrual migraine. This review will summarize the implications of these data for the treatment of women with menstrual migraine.